Director - Government Reimbursement

Responsibilities

• Organizing, coordinating, and performing the reimbursement function for Piedmont Healthcare and system entities, including the preparation of entity Medicare/Medicaid/Tricare cost reports, surveys, audits, appeals, budget and planning in an effort to assist management in operational and compliance decisions.
• Prepares and files Piedmont Healthcare Medicare/Medicaid/Tricare Cost Reports by applicable federal and state deadlines.
• Maintains all schedules and analysis supporting cost report preparation.
• Captures and coordinates Medicare and Medicaid audits and prepares all supporting work papers and documentation.
• Analyzes Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure accurate reimbursement and compliance with regulations.
• Works with senior management to research, analyze, and communicate reimbursement issues.
• Prepares pro-formas with regard to third party reimbursement.
• Maintains oversight of regulatory changes for compliance and seeks ways to optimize reimbursement.
• Aids Piedmont Healthcare and system entities with reimbursement percentages for use in calculating contractual reserves.
• Provides the Government Reimbursement Executive Director with research and ad hoc reporting, as directed.
• Prepares and assists Piedmont Healthcare and system entities with Medicare, Medicaid, and state surveys.
• Reviews and analyzes Medicare and Medicaid Remittance Advices to ensure proper payments.
• Ensures all third-party pass-through payments and lump sum adjustments are received as communicated by the Medicare Administrative Contractor (MAC) and account.
• Reviews cost report settlements for accuracy and compliance with regulations.
• Assists with appeal filings, where applicable, and coordinates cost report reopening reviews.
• Assists with graduate medical education reporting for Piedmont teaching facilities.
• Aids in the completion and timely submission of the Interns and Residents Information System (IRIS) software program to Medicare.
• Prepares the Allied Health reporting and reimbursement for cost report filing.
• Prepares the Wage Index and Occupational Mix Survey filings and reviews.

Qualifications

• Bachelor's Degree in Accounting or a related field is required.
• Master's degree in Accounting or a related field is preferred.
• Seven (7) years of government healthcare reimbursement and accounting experience is required.
• Experience with CMS PRM regulation manuals, the CMS 2552 software system, and the CMS IACS/EIDM system is required.
• A Certified Public Accountant (CPA) certification is preferred.