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Interim Reimbursement Business Specialist (IRBS)

The Interim Reimbursement Business Specialist is responsible for monitoring in-patient, out-patient, ancillary or physician services through the analysis of reimbursement methodologies (DRG’s, Medicare/Medicaid, Managed Care, per diem, etc.) and operational data for the purpose of identifying any potential clinical and/or reimbursement impact on the client. This position serves a variety of functions designed to obtain maximum efficiency in the gathering and reporting of information in order to evaluate and refine reimbursement methodology activities. It requires extensive contact with other departments, and their department heads, to ensure that objectives as they relate to reimbursement are met; that activities and problem areas are corrected; and opportunities to maximize reimbursement rates are addressed. Normally, the IRBS will report directly to the CFO or Controller.

  • Serves as the liaison between all Department and Medical Staff in gathering and disseminating information to appropriate personnel pertinent to case mix, reimbursement report analysis, and regulatory impact to their operations.
  • Develops, maintains and utilizes a case mix/reimbursement methodology database to substantiate projections.
  • Applies third party methodologies to the reimbursement database in order to analyze profitability of the various methodologies, including in-patient and outpatient revenues by various payors.
  • Gathers, compiles and analyzes case mix data in order to establish operational and reimbursement trends.
  • Calculates, reviews, and monitors reimbursement methodology payment rates.
  • Evaluates the impact of revisions to existing reimbursement payment methodology on the operational and revenue goals of the Department.
  • Develops, compiles and analyzes various reports related to the various reimbursement methodologies and other reimbursement activities.
  • Works with clinical staff in the development phase of specialty clinics/programs to develop and implement information reporting procedures necessary to maximize applicable reimbursement rates.

Basic Qualifications:

  • Bachelor’s Degree and three years of experience working with reimbursement methodologies (DRG’s, managed care, Medicare, Medicaid, etc.) for a third party payor, healthcare consulting firm, or in a hospital department of reimbursement, Patient Accounts or Accounting.
  • A Master’s Degree in Finance, Accounting, or Health / Hospital Administration is preferred.
  • Good knowledge of the principles and practices of hospital administration; good knowledge of reimbursement methodologies, including Diagnostic Related Groups (DRG’s) as they relate to hospital costs and expenditures.
  • Good knowledge of Medicare Prospective Payment System.
  • Familiarity with the operational organization of a large hospital and its various divisions; ability to identify and compile information used to prepare financial, statistical and narrative reports.
  • Ability to perform analytical reviews of rates and adjustments to ascertain their implications for hospital management.
  • Ability to deal effectively with a wide range of personnel; ability to communicate both orally and in writing.

Ability to use computer applications such as spreadsheets, word processing, and database software.


Submit Your Resume

We are currently accepting applications for future interim engagement needs. If your core experience falls into one of the following interim position categories, please submit your resume in Microsoft Word or PDF format. No phone calls please.

Spectrum Health Partners

341 Cool Springs Blvd
Suite 305
Franklin, TN 37067
Office: (615) 778-4650