Director Transplant Finance & Regulatory Compliance
Director of Transplant Finance and Regulatory is responsible for oversight of all transplant data and financial aspects of the abdominal transplant program and related services. Monitors the fiscal position of all program accounts and oversees analysis of financial data. Maintains current knowledge of all policies and oversee the billing processes and monitoring billing activity. Manages all budgeting, invoicing, and contract review, including RFI applications. Develops on-going performance improvement indicators together with industry benchmarks and trend analysis, monitors performance results and facilitates change in clinical/administrative protocols based on results. Responsibilities include oversight of outpatient practices and pre and post-transplant activities.
Develops, implements and manages standards of performance, policies and procedures related to capturing and tracking costs appropriately for Kidney, Liver and Pancreas Acquisition Cost Centers and for Medicare Cost Reporting including analysis of our payer mix.
Develops and maintains a system of reporting on-going financial analysis of existing contracts as well as overall transplant program expenses/revenues.
Responsible for coordination of key departments such as Admitting, Billing, Registration, Contracting, and Finance to ensure an efficient and streamlined process for patients and to maximize transplant revenues.
Responsible for cost accounting of transplant related services. Assists administration with decision- making based on cost/benefit analysis in order to ensure effective use of existing and future resources.
Maintains accurate and up-to-date knowledge of regulatory environment related to Medicare/Medicaid and commercial insurance reimbursement.
Responsible for ensuring regulatory compliance with all national, state and local certifications and accreditation regulations including but not limited to those of CMS, TJC, UNOS and NJ DOH.
Oversees activities of the Physician Practice Office Managers including oversight of all physician billing.
Assures the integrity and stability of revenue and billing data and provides direction for complex business decision making for operations. Provides direction and coordinates processes to ensure efficient operations and that adhere to billing regulations.
Oversees activities of the transplant data coordinator and maintains in-depth knowledge of current applicable standards and regulatory requirements for Transplant Programs and ESRD guidelines. Ensures accurate, complete and timely collection of clinical data for analysis and reporting.
Assists physicians, managers and staff in developing and updating departmental and external performance improvement plans based on the established performance indicators and strategic intents.
Assists with preparation of data reports and presentations for meetings/conferences including, QAPI Meetings and hospital PI Council meetings. Ensures that reports from departments and PI teams to the designated council and to the hospital-wide Quality Committee are complete and timely.
Oversees the budget preparation and monitors/responds to trends and variances accordingly.
Position Qualifications Required:
5-7 years of experience professional work experience in quality or billing a healthcare-related field.
Experience in a health care setting, preferably in the field of transplantation, desirable. This experience should include organ acquisition cost capture, cost accounting, budget and reimbursement, contract negotiation/compliance, financial analysis and reporting. Candidate should also have experience with the coordination of performance improvement activities, regulatory compliance methodologies and data tracking.
Computer proficiency is essential. Excellent verbal, written, presentation and training skills. Ability to analyze complex situations and implement coordinated, systematic solutions
College degree in relevant field required (i.e. Business, Accounting, Public Health, Health Administration, Nursing). Master’s degree preferred.
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