City/State:
Tarrytown, New York
Grant Funded:
No
Department:
REV - Finance & Reimbursement
Work Shift:
Day
Work Days:
MON-FRI
Scheduled Hours:
8:30 PM-5 AM
Scheduled Daily Hours:
7.5 HOURS
Pay Range:
$152,000.00-$190,000.00
Job Summary
Responsible for Montefiore Health System (MHS) reimbursement. Provides business, technical and project management expertise to guide cross-departmental workgroups to improve reimbursement throughout the health system. Reports to the Director of Finance and Reimbursement.
Essential Functions
- Assist in coordinating and maintaining hospital and professional reimbursement program for MHS hospitals, to ensure compliance with current payments, rules and legislative regulations that impact the medical center and ensure compliance with Medicare and Medicaid documentation guidelines.
- Manage, coordinate and assist in the activities of support personnel in operation of their respective functional duties within the Reimbursement Department, including the preparation of the MHS Medicare Cost Reports.
- Prepare the Medicare Settlement and related analysis.
- Assist in the management of GME related activities and analyses.
- Monitor and evaluate current reimbursement/payment rules and ensure that legislative and regulatory changes impacting MHS are evaluated on a timely basis.
- Establish and maintain procedures for accumulating accurate statistical data.
- Develop techniques for effective analyses of billing and collections efforts. Assist in the coordination of all field audits performed by third party auditors on Medicare/Medicaid Cost Reports; review and negotiate adjustment issues pertaining to these audits to properly ascertain reimbursement in accordance with state and federal regulations.
- Participates in the appeals process related to reimbursement, working with the department or with consultants for timely filing of cost report appeals and reopening requests to ensure maximum reimbursement.
- Investigate and implement strategies that will support optimization of MHS reimbursement.
- Participate in committees as required to facilitate an increased awareness of reimbursement related issues.
- Obtain and review correspondence, proposed regulations, revisions with third party agencies, Medicare, Medicaid and the Department of Health regarding matters of payment for MHS services and communicate these changes and requirements to Information Systems, Finance and other departments affected by these changes.
- Plan and conduct meetings with associates to ensure compliance with established practices, to implement new policies and to keep employees aware of changes and current standards.
- Analyze Medicaid Hospital Rates including recommendation of appeals.
- Analyze and post rate liabilities to the General Ledger.
- Assist in the analysis of National Institute of Health (NIH) Cost Report and related activities.
- Assist Revenue Cycle with rate related input and questions regarding implementation of Medicare, Medicaid, commercial and managed care contracts.
Qualifications
- Bachelor’s degree or equivalent experience required
- At least 5-7 years of financial management experience in the health care industry.
- A demonstrated ability to manage finance functions in a complex, challenging and diverse environment.
- A demonstrated ability to build and supervise experienced finance professionals.
- Excellent written and communication skills.
