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Director of Medicare/Medicaid & Third Party Reporting

Farmington, CT

Posted: 04/26/2019 Employment Type: Retained Industry: Executive Level Job Number: 6622 Salary / Pay Rate : $135,000 - $145,000

DIRECTOR, MEDICARE/MEDICAID & THIRD PARTY REPORTING

J. Morrissey & Company has been retained UConn Health for the executive search for the Director, Medicare/Medicaid & Third Party Reporting  who is responsible for  financial preparation, analyses, and governmental reporting to various agencies; including:
  • Agencies: CMS, Connecticut Department of Social Services, and Connecticut’ s Office of Health Strategies. 
  • Specific reporting areas: Annual Cost Reports; Office of Health Strategy Annual and 12 Month reports; Wage Index, DSH, and HITECH filings; 340B, OIG, and Rural Referral Center Status Reporting. 
  • Responsible for monitoring changes in the Federal Register and/or other authoritative literature pertaining to reimbursement payments; modelling the impacts of such changes resulting in the presentation of a gross to net breakdown for patient revenues. 
  • Acts as a the lead in the filing of the Rate Agreement for Research Patient Care with the Department of Health and Human Services Department of Cost Allocation.
  • Monitors, summarizes and drafts white paper analyses of regulatory and legislative changes in reimbursement or regulatory reporting which impact budgetary revenue projections or current operational processes. Prepares models replicating changes by rate setters on current and projected patient populations.
  • Establishes and implements policies and procedures along with business plan templates for the evaluation and implementation of new revenue programs for the Health Center including insurance coverage implications, FDA approvals, off label usage and site of service billing and reimbursement.
  • Assists in the investigation of compassionate use options for non-covered services and/or procedures which support the mission of UConn Health.
  • Responsible for preparing and maintaining the third party reserve schedule on a monthly basis.

Working with the Associate VP of Revenue Integrity, the Director also assists with proposing and managing Hospital and physician specific charging and reporting policies, revenue capture, compliance procedures that are necessary to ensure the fiscal integrity of such policies and reporting.

The Director works closely with Budget, Finance, and Operational units to ensure all are kept updated on changes in potential payments.

Qualifications:

The successful candidate will have the following requirements:
  • Bachelor' s degree in Accounting, Finance, healthcare or public administration or related field
  • Five (5) years professional experience that includes extensive experience with financial statements, management information preparation and analysis; and managing large projects
  • Experience in filing and reopening cost reports, interpreting and modelling payment methodologies, and synthesizing large amounts of data into actionable information.
  • Extensive and demonstrable knowledge of federal/state regulations pertaining to those governing reporting for Medicare, Medicaid, CHAMPUS, OPM and OHS;
  • Extensive data management abilities with a variety of systems and a proven ability to learn new systems;
  • Ability to incorporate technology into financial reporting processes;
  • Proficient in Excel, Access, and data querying, possessing the knowledge to manipulate large data sets for reporting and data analysis summaries to senior management.

 

 

Donna McCarty, CPC
Senior Vice President & CAO

Donna R. McCarty, CPC has over 30 years of experience in the healthcare industry within Connecticut and nationally. Donna has been associated with area hospitals, a health maintenance organization and a national home infusion therapy company.  In these settings, she had the opportunity to be involved in every facet of healthcare, primarily in financial and administrative capacities.

As Senior Vice President & CAO, Donna performs executive searches for leadership roles in healthcare and non-profit organizations. She is also responsible for compliance, contracting, education, public relations, and on-boarding of new employees at J. Morrissey.

Donna’s community involvement includes a longstanding relationship with Prevent Blindness Connecticut.  She has served two terms as board chair, was the 1998 recipient of the Robert and Joyce Polk Award for distinguished service, and the 2001 recipient of the Cincinatus Award for outstanding service and dedication.  She was also the past president and founder of the Greater Hartford Chapter of the Quinnipiac University Alumni Association and was a member of the Quinnipiac University National Alumni Board of Governors for 18 years.  Donna has also served as past president of the Connecticut Women in Health Care Management, served on the UCONN Health Care Management Advisory Board for the university’s undergraduate and graduate health care programs, and The Hartford Courant CareerbuilderRx Advisory Board. Most recently, she was co-chair for Relay For Life in Plainville, CT in 2008-2010. Donna was a founder and president of Women Executives in Healthcare until 2016.

Donna is a 1990 cum laude graduate of Quinnipiac University with a Bachelor of Science degree in Health Management. 

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