Reimbursement Manager - Reimbursement and Revenue Integrity - FT - Days - MHS
About the role
The Reimbursement Manager assists Directors and the Vice President of Reimbursement & Revenue Integrity with tasks such as Medicare and Champus cost reporting and audits, interim rate and settlement calculations, Medicaid waiver reports, maintenance of net revenue preparation and analysis, and various other projects.
Responsibilities
- Stay current with Medicare/Medicaid and other third party payor regulations and determine their impact on the System.
- Monitor and research state and federal requirements to ensure compliance and timely communication to all affected parties.
- Prepare and input data for annual Medicare, Medicaid and Champus cost reports, including audit schedules and account reconciliations.
- Maintain and update various cost report statistics like time studies, meal counts, and square footage.
- Coordinate responses to external audits and consultants for Medicare DSH payments, Bad Debt, Appeals, IME, and GME payments.
- Develop responses to Medicare reviews, including Wage Index and Occupational Mix Surveys.
- Compile and analyze Medicaid DSH and Low Income Pool (LIP) supporting schedules and final reports.
- Draft audit responses and develop strategic plans for payment enhancements.
- Prepare monthly and annual financial statements related to net revenue and support the annual accounting audit.
- Maintain roll forward schedules of third-party settlement balances and their application for the monthly close process and annual financial audit.
- Review and approve outside consultant invoices for Medicare Transfer reimbursement improvements.
Competencies
- ACCOUNTABILITY
- ACCOUNTING - COST REPORTS
- ACCURACY
- CUSTOMER SERVICE
- FINANCIAL ANALYSIS
- HEALTHCARE REGULATORY ENVIRONMENT
- REGULATORY COMPLIANCE
- RESPONDING TO CHANGE
- STANDARDS OF BEHAVIOR
- WORKLOAD MANAGEMENT
Education and Certification Requirements
- Bachelor's Degree (Required)
Additional Job Information
- Complexity of Work: Requires critical thinking, effective communication, decisive judgment, and the ability to build and foster positive relationships. Must lead others and take appropriate action when required.
- Knowledge: Thorough knowledge of Medicare, Medicaid, and Champus rules and regulations, and Third party audit techniques. Proficiency in Microsoft Office products and Cost Reporting Software.
- Experience: Five (5) years of progressively responsible experience in hospital reimbursement operations, audit, or consulting, including projects specifically related to Medicare and Medicaid reimbursement.
Functionality
- Bending and Stooping: 0%
- Climbing: 0%
- Keyboard Entry: 60%
- Kneeling: 0%
- Lifting/Carrying Patients: 0%
- Lifting or Carrying 0 - 25 lbs Non-Patient: 60%
- Lifting or Carrying 2501 lbs - 75 lbs Non-Patient: 0%
- Lifting or Carrying > 75 lbs Non-Patient: 0%
- Pushing or Pulling 0 - 25 lbs Non-Patient: 0%
- Pushing or Pulling 26 - 75 lbs Non-Patient: 0%
- Pushing or Pulling > 75 lbs Non-Patient: 0%
- Reaching: 40%
- Repetitive Movement Foot/Leg: 0%
- Repetitive Movement Hand/Arm: 0%
- Running: 0%
- Sitting: 20%
- Squatting: 0%
- Standing: 0%
- Walking: 0%
- Audible Speech: 0%
- Hearing Acuity: 0%
- Smelling Acuity: 0%
- Taste Discrimination: 0%
- Depth Perception: 0%
- Distinguishing Color: 0%
- Seeing - Far: 60%
- Seeing - Near: 0%
- Bio hazardous Waste: 0%
- Biological Hazards - Respiratory: 0%
- Biological Hazards - Skin or Ingestion: 0%
- Blood and/or Bodily Fluids: 0%
- Communicable Diseases and/or Pathogens: 0%
- Asbestos: 0%
- Cytotoxic Chemicals: 0%
- Dust: 20%
- Gas/Vapors/Fumes: 0%
- Hazardous Chemicals: 0%
- Hazardous Medication: 0%
- Latex: 0%
- Computer Monitor: 60%
- Domestic Animals: 0%
- Extreme Heat/Cold: 0%
- Fire Risk: 0%
- Hazardous Noise: 0%
- Heating Devices: 0%
- Hypoxia: 0%
- Laser/High Intensity Lights: 0%
- Magnetic Fields: 0%
- Moving Mechanical Parts: 0%
- Needles/Sharp Objects: 0%
- Potential Electric Shock: 0%
- Potential for Physical Assault: 0%
- Radiation: 0%
- Sudden Decompression During Flights: 0%
- Unprotected Heights: 0%
- Wet or Slippery Surfaces: 0%
- Shift Primarily for office workers - not eligible for shift differential
Disclaimer
This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post-offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email TalentAcquisitionCenter@mhs.net