Reimbursement Manager

Key Responsibilities / Essential Functions

• Serves as primary resource for the DCH Health Care Authority to monitor and interpret Federal and State reimbursement regulations.
• Develops strategies to ensure proper reimbursement.
• Maintains proficiency in the use of the Federal Register and a thorough knowledge of Medicare, Medicaid, Tricare (Champus) and Blue Cross-reimbursement principles and regulations.
• Directs and assists with accurately preparing, completing, and reviewing any regulatory reports required by third-party and governmental agencies regarding Authority reimbursement.
• Serves as the primary liaison with external auditors and government agencies.
• Reviews and ensures proper third-party reimbursement.
• Maintains awareness of federal and state legislative changes impacting hospital reimbursement and influences policy.
• Ensures contractual accruals and settlement estimates are accurate by oversight and full understanding of the contractual deduction process.
• Afford assistance in the preparation of budget calculations relating to 3rd party reimbursement to include contractual adjustment estimates.
• Researches and provides recommendations regarding the Core-Based Statistical Area enrollments to determine wage index classification.
• Prepare interim calculations to project estimated third-party rates of reimbursement.
• Oversee formal appeals when necessary.
• Completes Medicaid Assister Program each quarter.
• Performs monthly operating reviews for assigned departments.
• Prepares and files annual cost reports or any amendments.
• Coordinates appeals for Medicare cost reports.
• Responsible for the oversight of the DSH and S-10 filings.
• Monitors reimbursement workflow and directs staff to ensure all daily tasks are accomplished.
• Responsible for overseeing all governmental reimbursement audits.
• Actively works to maintain and improve area wage index and occupational mix adjustment.
• Prepare for and respond to year-end audits by third-party auditors.
• Manages departmental budget.
• Interviews, selects, hires, and retains employees.
• Ensures orientation and training for employees.
• Manages performance.
• Promotes, demotes, or transfers employees to meet organizational needs.
• Executes employee accountability process up to and including termination.
• Manages departmental productivity standards.
• Performs compliance requirements.
• Approves payroll and is responsible for accurate payment of employees.
• Manages front line operations of area of accountability related to meeting/exceeding departmental goals

DCH Standards

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook.
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.