THR VP Gov Reimb Medcaid Pmts

This VP Government Reimbursement & Medicaid Supplemental Payments directs, administers and coordinates activities related to reimbursement from Third-Party governmental programs for all system entities and is crucial to protecting THR’s access to funding for safety-net services through various supplemental payment programs.

The VP Government Reimbursement Medicaid Payments has the following duties and responsibilities:

• Responsible for the overall direction, coordination, and evaluation of the government reimbursement program, providing centralized leadership and oversight to ensure optimal participation in safety net funding opportunities in programs promulgated by CMS and TxHHSC.  The programs include 1115 Waiver or other CMS Waiver programs, Directed Payment Programs (DPP’s), and any future programs not yet in place aimed at funding safety-net services (collectively referred to as MSP’s).
• Actively participate and represent THR’s interest in local and statewide forums for vetting program information, options, and changes. These forums include local safety net organizations such as TSN and DSN, meetings with local and state government entities such as public hospitals, TxHHSC, etc. and trade association and organized constituent groups such as THA, TEHP, TAVH, G5, etc.  Will interface pertinent content with THR governmental relations staff.
• Ensures entity leaders deploy and operationalize MSP programs on time and consistent with requirements for reporting and achieving payment.
• Serves as a liaison and subject matter expert in support of entity leaders and staff to enable and improve operational problem solving across the system for DPPs and other programs. 
• Oversees or supports departments and entities with various Medicare and Medicaid Supplemental Payment and incentive programs including but not limited to DSH, Meaningful Use, 340B and the Medicaid Waiver. 
• Serves as a liaison among channel and entity executives to enable and improve operational problem solving across the system for MSP programs.
• Directly works with THR government relations, accounting, legal, and governmental reimbursement staff to assure accurate understanding and recording of financial transactions related to LPPF and MSP programs.
• Manges outside consulting relationships including but not limited to the review and preparation on of Medicare/Medicaid cost reports, regulation appeals, Disproportionate Share Hospital (DSH), and Wage Index and other relationships related to supplemental payment programs.  
• Routinely conducts surveillance of state and national supplemental payment and program financing (IGT) developments. Provides continued feedback and assessment of potential impact to THR senior leaders and government relations staff regarding program risks and opportunities from programs developing or originating outside of Texas. 
• Responsible for providing financial consulting and representation on various Medicare/Medicaid regulations.
• Leads resolution of reimbursement issues for Medicare/Medicaid and represents System hospitals in negotiations with the fiscal intermediary.
• Sets annual Medicare and Medicaid reimbursement rates for budget and extended forecasting. Estimates and communicates the financial impact of regulatory and operating changes on Third Party reimbursement. 
• Assembles periodic status reports for the THR Executive Team regarding THR supplement payment program progress, expected funding, program changes, and material risk.
• Oversees the timely filing of regulatory enrollment, Medicare/Medicaid cost reports for all wholly owned system and managed joint venture facilities. Monitors Medicare/Medicaid contractual accounts for proper valuation. Coordinates all Medicare and Medicaid audits. 
• Reviews all submissions to TxHHSC and other governmental agencies related to MSP programs for accuracy and consistency, ensuring adherence to specifications.  This includes working collaboratively with subject matter experts within THR (i.e., THR’s population health, quality, government relations, finance/accounting, etc.)  that are tasked with gathering and assembling data and information per reporting requirements.