Reimbursement Manager

Overview

The Reimbursement Manager ensures compliance with regulations related to governmental and commercial reimbursement programs and works to mitigate the risk of loss of income and seize opportunities to provide value throughout the reimbursement process.  This includes completion of governmental cost reporting, payor audits and providing interim reimbursement estimates.

Responsibilities

Key Responsibilities / Essential Functions

Serves as primary resource for the DCH Health Care Authority to monitor and interpret Federal and State reimbursement regulations. Develops strategies to ensure proper reimbursement. Maintains proficiency in the use of the Federal Register and a thorough knowledge of Medicare, Medicaid, Tricare (Champus) and Blue Cross-reimbursement principles and regulations.

Directs and assists with accurately preparing, completing, and reviewing any regulatory reports required by third-party and governmental agencies regarding Authority reimbursement.

Serves as the primary liaison with external auditors and government agencies.

Reviews and ensures proper third-party reimbursement.

Monitors federal and state legislative changes for upcoming changes associated with governmental payor plans that impact hospital reimbursement and is aware of opportunities to influence policy.   

Ensures contractual accruals and settlement estimates are accurate by oversight and full understanding of the contractual deduction process.

Assist in the preparation of budget calculations relating to 3rd party reimbursement to include contractual adjustment estimates.

Researches and provides recommendations regarding the Core-Based Statistical Area enrollments to determine wage index classification.

Prepare interim calculations to project estimated third-party rates of reimbursement.

Oversee formal appeals when necessary.

Completes Medicaid Assister Program each quarter.

Performs monthly operating reviews for assigned departments.

Prepares and files annual cost reports or any amendments.

Coordinates appeals for Medicare cost reports.

Responsible for the oversight of the DSH and S-10 filings.

Monitors reimbursement workflow and directs staff to ensure all daily tasks are accomplished.

Responsible for overseeing all governmental reimbursement audits.

Actively works to maintain and improve area wage index and occupational mix adjustment.

Prepare for and respond to year-end audits by third-party auditors.

Manager

• Manages departmental budget
• Interviews, selects, hires, and retains employees
• Ensures orientation and training for employees
• Manages performance
• Promotes, demotes, or transfers employees to meet organizational needs
• Executes employee accountability process up to and including termination
• Manages departmental productivity standards
• Performs compliance requirements
• Approves payroll and is responsible for accurate payment of employees
• Manages front line operations of area of accountability related to meeting/exceeding departmental goals

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned

Qualifications

Education:       Bachelor of Science or Bachelor of Business Administration degree with a degree in Accounting required. Master’s Degree in Business Administration or CPA preferred.

Experience:      Six (6) years of accounting experience required.

Four (4) years of experience in the hospital field or in the public accounting field performing audits for a hospital or intermediary client and completing cost/contribution margin analysis required. 

Four (4) years’ experience in a position of supervisor responsibility preferred. 

Prior experience completing cost reports for government programs preferred.

Must be able to read, write legibly, speak, and comprehend English. 

WORKING CONDITIONS

WORK CONTEXT

• Frequent contact with others: deals with internal and external customers, face-to-face discussions, email and telephone communications.  Possible dealings with unpleasant or angry people, public speaking, and conflict situations/resolution.
• Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range.  Able to perform the duties with or without reasonable accommodation.
• This job requires very exact and highly accurate performance and may require the meeting of strict deadlines on a daily basis
• May require work hours outside of regular work schedule

PHYSICAL FACTORS

• Activities: Talking, hearing, bending, twisting, walking, kneeling, crouching, stooping, balancing, reaching, pushing, pulling, lifting, grasping, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls
• Requirements: Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
• Good manual and finger dexterity. 
• Must be able to perform the duties with or without reasonable accommodation.
• Hearing and vision must be normal or corrected to within normal range.

KEY WORD SEARCH

Cost report, Medicare, reimbursement, analysis, regulations, Federal, State, Medicaid, audits, work papers, third-party