The Opportunity: By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.
This role will serve in a consultancy capacity, advising our clients-large health systems-in managing and optimizing healthcare reimbursement processes, focusing on Medicare, Medicaid, Disproportionate Share Hospital (DSH) programs, Medicaid Directed Payment programs, and 340B drug pricing and reimbursement. Additionally, this position provides key support in the preparation and analysis of Medicare cost reports, ensuring compliance with federal regulations and maximizing financial performance for healthcare providers.
Essential Job Functions
- Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
- Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.Striving for Excellence: Execute at a high level by demonstrating our "Best in KLAS" Ensemble Difference Principles and consistently delivering outstanding results.
- Assist in gathering and analyzing data for the preparation of Medicare cost reports, ensuring accurate reflection of hospital costs for reimbursement optimization.
- Provide expert advice on reimbursement strategies for governmental lines of business, including Medicaid and Tricare
- Support 340B program compliance, eligibility, and ensure correct billing processes.
- Analyze hospital eligibility for DSH payments, assess financial impact, and ensure complete and accurate capture of Medicaid days and other considerations.
- Monitor Medicaid Directed Payment programs, optimizing revenue opportunities for participating providers.
- Serve as a trusted advisor to clients, offering strategic insights and recommendations on reimbursement-related matters.
- Maintain expert-level knowledge of state and federal healthcare reimbursement policies, ensuring strict compliance with CMS guidelines, Medicaid Managed Care rules, and HRSA 340B program regulations..
- Assist healthcare providers in navigating reimbursement complexities, including audits, appeals, and compliance inquiries.
- Analyze financial data to identify trends and areas for improvement in the reimbursement process.
- Build and maintain strong relationships with payers, government agencies, and other stakeholders.
- Provide guidance and training to client staff on reimbursement regulations and best practices.
Job Competencies
- Leadership Decision Making - Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.
- Coaching & Building Talent - Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.
- Delegation - Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.
- Executive Communication - Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others' attention (appropriate, impactful, and clear).
- Program/Project Management - Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.
Other Preferred Knowledge, Skills and Abilities
- Strong analytical, communication, and negotiation skills.
- Ability to work effectively in a fast-paced and ever-changing environment.
- CPA Licensed
- Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.
- This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.
This position pays between $134,000- $200,000 based on relevant years of experience.
