The Reimbursement Manager is responsible for the collecting, organizing and summarizing of data that is used for external reporting to State and Federal agencies as well as internal financialreporting and analysis for one or more MHS facility. Working under the general direction of the Executive Director, independently determines and develops solutions, with final work product reviewed by the Executive Director.
A complete understanding of technical principles, theories and concepts related to Medicare/Medi-Cal hospital reimbursement is needed as well as the ability to apply them to a wide range of problems. The Manager acts as an internal consultant on reimbursement issues facing the Corporation to ensure just reimbursement to the facilities.
Essential Job Outcomes & Functions
- Oversee the planning, development and coordination of the preparation and documentation of Medicare, Medicaid, OSHPD and other external cost reports as appropriate for assigned facilities; help ensure adherence to all third-party reporting requirements. Suggest improvements to current processes to ensure compliance with regulations as well as efficiency of data gathering.
- Coordinate the support for governmental and financialaudits of cost reports and other analyses for third-party filings; help ensure the accurate settlement of all issues. Support the Reimbursement Specialist(s) by providing guidance on dealing with fiscal intermediaries during the audit process.
- Oversee the preparation of appeals and re-openings of cost reports and supporting analyses for assigned facilities; help ensure the accurate and timely settlement of all issues. Support the Reimbursement Specialist(s) (if any) in their efforts with researching and writing appeals.
- Prepare and support the calculation of revenue deductions, contractual allowances and other reserves and settlement accounts for assigned facilities; help ensure the accuracy of monthly and annual financialreporting.
- Establish and maintain courteous and cooperative relationships with internal and external contacts, both suppliers and users of departmental data; help ensure open channels of communication.
- Maintain current knowledge of system operations, federal and state regulations, impacting the various external cost reporting requirements; help ensure MHS compliance with applicable laws.
- Prepare impact analysis of changes in regulations and be able to communicate these changes to hospital
Minimum Requirements / Work Experience
- This position requires a thorough working knowledge of the rules and regulations related to third-party cost reporting and payment systems as well as broad knowledge of hospital operations.
- A minimum of six (6) years of progressive government reimbursement experience is required, preferably a mix of fiscal intermediary and hospital experience.
- Must be analytical, self-motivated, and able to work independently.
- Requires proficient computer skills, including the use of Microsoft Excel, Microsoft Word, and Cost Reporting software.
- Microsoft Access experience desirable.
Education / Licensure / Certification
- This position requires a Bachelors Degree in Accounting, Finance, Economics or Business Administration.