Manager Reimbursement
Description
Summary :
The primary purpose of the Reimbursement Manager is toensure proper payments are received from Third Party programs andproper accounting of such programs is maintained.
This will beaccomplished through completion and review of monthly contractualrelated income statement and balance sheet accounts and properfiling, audit and settlement of cost reports.
The SystemReimbursement Manager is responsible for the reimbursement functionof multiple facilities. The complexity of the facilities mayinclude acute care, rehabilitation unit, psychiatric unit, skillednursing facility, medical education, End Stage Renal Disease, OrganTransplant and Disproportionate Share.
The System ReimbursementManager spends a significant amount of time supporting theCorporate Reimbursement Department, on projects as needed.
Theneeds could include and are not limited to regulatory analysis,financial analysis, system-wide reopening or reporting issues.
Thisposition requires diligent values of integrity and compliance withall applicable Regulations.
- Prepareand review monthly contractual allowance journal entries andsupporting calculations and responsible for proper balances inassociated income statement and balance sheet accounts, formultiple facilities
- Scope of accountingresponsibility includes Medicare, Medicaid, USFHP, CHAMPUS, BlueCross, Worker's Compensation and ManagedCare
- Analyze monthly contractual allowancevariances, providing detailed explanations for significantfluctuations to Hospital Administration for use during closemeetings
- Maintain current, correct accountanalysis' related to program Income Statement and Balance Sheetaccounts
- Ensure monthly reports are preparedtimely and accurately by supporting departmentalAssociates
- Prepare final hospital and homeoffice cost reports, completing comparative analysis of the costreport versus the financial statement and compliance checklistprior to submission, for multiplefacilities
- Ensure Medicare, Medicaid andCHAMPUS cost reports are submitted by due dates to prevent loss ofreimbursement to the facilities
- Identify andpursue proper reimbursement methodologies in an effort to receiveall reimbursement due based upon Medicare, Medicaid and CHAMPUSRegulations
- Coordinate the Medicare FieldAudits, ensuring complete, proper and timely information isprovided and audit adjustments are reviewed prior to issuance ofthe settlement
- Errors found must becommunicated in writing to the Auditors during the audit, to ensureproper settlement and issuance of the Notice of ProgramReimbursement
- Prepare audit adjustment analysisto determine reimbursement impact of adjustments to as filedreport
- Act as a liaison to the ExternalFinancial Auditors for both the interim and final audits, formultiple facilities
- Review settled cost reportsprior to final reopening deadlines to ensure the reports wereappropriately settled
- Prepare and submit costreport reopening requests to obtain additional reimbursement dueand otherwise make requests for corrections asappropriate
- Prepare and submit appeals andsubsequent position papers to appeal inappropriate settlements withthe PRRB, for assigned facilities
- Assist inpreparation of Social Accountability and Community Needs reportsrequired as part of annual budgetprocess
- Respond to requests from HospitalAdministration and other internal and hospital departments in areaswhere reimbursement knowledge isrequired
- Analyze and inform HospitalAdministration of financial impact of operational decisions, asrequested
- This may include preparation ofpro-forma analysis and due diligence for new and existing businessopportunities and informing Management and Hospital Administrationof proposed / final rules and Regulations, which could impact thehospitals' operations
- Assist in maintenance ofrate tables for Medicare, Traditional Medicaid and CHAMPUS in aneffort to ensure proper payments arereceived
- Monitor interim payment rates and workwith the Intermediary to ensure proper payments are beingmade
- Participate on the performance initiativeto track, review and reduce denials
- Assist withcontract rate issues as requested
- Collaborateon cross-functional teams to address System standardization needsof processes where reimbursement expertise isrequired
- Assist in authoring thorough, accuratepolicies and procedures for standardized and transparentprocesses
- Assist Accounting and Business Officedepartments with the cash reconciliation process for settlementsand interim payments
- This includes identifyingand communicating errors or issues found to thesedepartments
- Maintain knowledge of currenttrends and developments in the field by reading appropriate books,journals, and attending related seminars andconferences
- Actively participate as a member inHFMA as a representative of CHRISTUSHealth
- Assist Director and Senior Managers ofReimbursement Department including education, annual reimbursementconference and other projects
Requirements :
Bachelor's Degree
Work Type : Full Time
Full Time
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