Associate Director, Revenue Cycle Reimbursement Assurance

JOB POSTING:

The successful candidate for this role will have a passion for ensuring that Vanderbilt University Medical Center's Hospitals and Providers are reimbursed according to managed care contracts and governmental policies for the medical services provided to our patients.

Other qualities for the successful candidate are polished and professional presentation skills, creative problem solving, and business process redesign with a particular interest in solutions involving automation. Experience with interpreting Managed Care Contracts fee schedules and payer policies is required.

JOB SUMMARY:

This strategic leader will provide overall guidance for the Reimbursement Assurance team by developing goals, objectives, policies, and procedures, supervising, coordinating, and evaluating activities, participating in operating and capital expenditure budgets preparations, and performing personnel administration functions. This role is a critical element of our high-performing revenue cycle.

KEY RESPONSIBILITIES:

• Oversee, monitor, and manage Reimbursement Assurance functions, including identifying and trending underpayments, communicating with payer representatives, and collaborating with our Managed Care team.
• Oversee, monitor, and manage underpayment vendor activities to meet organizational Key Performance Indicators and business unit goals.
• Report regularly to various leaders in the institution on the status of the team's work efforts.
• Ensure strict adherence to Reimbursement Assurance internal controls, policies, and procedures
• Guide efforts to streamline and automate processes to improve efficiency and accuracy in all areas of the department

GENERAL EXPECTATIONS:

Leadership :

• Provide leadership and model behavior to promulgate the mission and the values of the institution to the department
• Create an organizational culture (both within and across departments) that provides a safe, satisfying, and enriching environment for employees and provides qualified, competent staff to meet patient and departmental needs
• Create an environment that encourages and supports self-development and learning for all staff through regular feedback

Goals and Objectives:

• Develop departmental plans and objectives based on interpretation of institutional policy and goals.
• Achieve goals and objectives by developing project plans with timelines and milestones and holding staff and peers accountable to meet agreed-upon deadlines

Performance Improvement:

• Analyze and evaluate ongoing department programs to identify areas where adjustments/improvements are needed
• Initiate changes in or develop new policies, procedures, and methods.
• Prioritize, initiate and oversee efforts to automate processes to optimize accuracy and efficiency
• Participate in departmental and interdepartmental committees to address problems and facilitate information exchange about programs, questions, etc.
• Identify, establish, and evaluate quality assurance standards, programs, and procedures within the department

Departmental Management:

• Analyze and assess budget variances
• Prepare justification or develop alternatives for cost containment/reduction
• Establish and evaluate standards of performance to ensure safe, effective, and efficient operation of the department
• Ensure departmental adherence to all Human Resource and VUMC policies and procedures
• Participate in periodic management meetings to keep top management informed of departmental problems and concerns
• Create and exceed service standards utilizing key service dimensions and knowledge of patient/customer expectations and best practices

Staff Management:

• Develop staffing plans to meet developmental objectives

• Define the qualifications and performance expectations for all staff positions through the Performance Development system, including department-specific job descriptions and measurable performance standards. Ensure staff development through orientation, training programs, and work experiences
• Assess staff competencies against performance expectations stated in their job descriptions (typically annually)

• Supervise the team to ensure coordination and control of the work and procedures; provide advice/consultation to staff on escalated issues

• Adjust work schedules or project priorities to meet emergencies or changing conditions

Qualifications - External

Bachelor's Degree (or equivalent experience) and five years' experience