Director of Managed Care & Reimbursement
Resume:
Carl A. Horowitz
Fort Lee, New Jersey 07024
201-***-**** (Home)
201-***-**** (Cell)
Objective: A challenging administrative financial position in the
healthcare field with the potential for professional growth.
Summary of Experience: Presently Director of Reimbursement & Managed Care
for a Hospital and Nursing Home in Westchester. Director of Financial
Planning for a Large (Group One) - Teaching hospital. Consultant for
prestigious Big 5 Accounting firm. Over Eighteen year's hospital
administrative experience as Director of Reimbursement for two large
teaching hospitals. Four years as Senior Auditor performing a variety of
third party reimbursement audits for Blue Cross and Medicare.
.
Work Experience:
October 2004 - St. Joseph's Medical Center
Present 127 South Broadway
Yonkers, New York
Director of Reimbursement and Managed Care
Responsibilities include negotiating managed care
contract language
and reimbursement rates with Health Maintenance
Organizations
(HMO's) and all other reimbursement related tasks
for the hospital
and nursing home that includes the compilation and
filing of the
Hospital's DSH Tool and Audit Tool. Also
maintenance of the charge
description master (CDM), preparation of the
revenue portion of the
annual budget report, as well as compilation of the
year end third
party rate accounts.
February 2001 - St. Luke's / Roosevelt Hospital Center
October 2004 555 West 57th Street
New York, New York 10019
Director of Financial Planning
Responsible for keeping abreast of changing
regulations for 1,087
bed hospital. Primary responsibilities include
preparation of the
revenue portion of the final budget report, and
the ICR Cost Report
and Mental Health Supplement with 15 programs.
Other
accomplishments include the compilation of the
actual vs. budgeted
monthly revenue that includes detailed rate
calculations for capital,
IME, GME, and various pools components, etc.
April 2000 - Nyack Hospital
January 2001 160 North Midland Avenue
Nyack, New York, 10960
Director of Financial Planning & Reimbursement
Primary responsibilities include preparation of all
expense and
revenue portions of the annual budget report, cost
reporting
responsibilities, profit & loss analysis and
compiling cost accounting
reports utilizing the Trendstar system.
.
December 1997 - KPMG Peat Marwick, CPA, LLP
March 2000 123 Main Street
White Plains, New York 10601
Senior Consultant - Health Care
Assurance Division - Reimbursement
Field Audit review of Year-End - 3rd Party Due
To / Due From
Accounts for many metro-area hospitals. The
analysis also
included an estimation of final settlements with
detailed rate
review expertise in areas that include
Disproportionate Share
Payments (DSH), O/P Settlements, GME, IME,
Capital, Bad Debt
Pools, DRG Creep, and Volume Adjustments.
June 1984 - Elmhurst Hospital Center
November 1997 79-01 Broadway
Elmhurst, New York 11373
Associate Director of Reimbursement
Supervision of ten-member professional staff
including four senior
analysts. In-depth knowledge of NYHCRA-NYS
Regulations, third
party rate appeals and preparation of the
financial schedules for
various CON applications.
June 1982 - Peninsula Hospital Center & Nursing Home
June 1984 51-15 Beach Channel Drive
Far Rockaway, New York 11691
Manager of Reimbursement & Budget
Maximization of third party inpatient and
outpatient rates, with
the compilation of the final budget report and
various surveys.
December 1977 - Empire Blue Cross and Blue Shield
May 1982 3 Park Avenue
New York, New York 10017
Senior Auditor - Provider Audit Division.
Field verifying financial reporting from the ICR
and Supplement or
the SSA 2552.
Education: Lehman College, Bronx, New York 10468
Bachelor of Arts, Accounting
Pace University, Graduate Courses
Professional HFMA Advanced Member, HFMA Follmer Award
Memberships: Coordinator, HFMA, APC's Committee, 2000 Annual Institute
References: References will be furnished upon request.
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