Reimbursement Manager @ Inova

Accounting (1)

Inova Health is looking for a dedicated Reimbursement Manager to join the team, this role will be full-time day shift Monday-Friday, 8:00 a.m.- 5:00 p.m., Remote

The Reimbursement Manager develops, prepares, and presents the financial impact of all new and proposed Medicare/Medicaid regulations to senior management. Directs the development of contractual allowances for budget projections. Takes ownership of Graduate Medical Education and Indirect Graduate Medical Education reimbursement. Manages, directs, and assists in the preparation and/or review of preliminary and filed Medicare/Medicaid cost reports. Manages daily operations of the reimbursement group, including staff assignments and prioritization of projects. Stays abreast of Medicare/Medicaid regulations and works to ensure that Inova Health System's facilities stay in compliance with regulations within the scope of assigned duties.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules.

Reimbursement Manager Job Responsibilities

Directs the preparation of reimbursement studies as needed by senior management.
Researches regulations related to the implementation of new programs, services, and ventures.
Researches regulations for developing techniques for maximizing reimbursement.
Prepares and coordinates the necessary journal entries and explanations for monthly processing.
Directs the evaluation of interim payments from third-party payers for accuracy and adequate cash flow.
Coordinates with Information Systems regarding the production of reports for cost reporting/analysis purposes.
Reviews Generally Accepted Accounting Principles and auditing standards as they apply to the reimbursement area.
Develops and conducts reimbursement seminars for the staff of Health Information Systems (HIS) operating units.
Prepares work papers for the Home Office cost statement and defends them when audited.
Takes ownership of Graduate Medical Education (GME) and Indirect Graduate Medical Education (IGME) reimbursement. Stays abreast of all Centers for Medicare & Medicaid Services regulatory changes that impact GME/IGME reimbursement.
Works with the GME Office to maintain documentation on the GME Program to support cost reports.
Completes the IRIS report for submission to Medicare annually.
Prepares Home Office work papers and Home Office cost statements for submission to Medicare and Medicaid.
Reviews Medicare/Medicaid settlements for accuracy and impact on reimbursement for all HIS entities.
Takes ownership of the appeal of cost reports. Prepares position papers for filing with the Provider Reimbursement Review Board.
Work with the GME Office to maintain the necessary documentation to count residents for GME/IGME reimbursement.
Stays abreast of GME/IGME regulations. Reviews filed cost reports for accuracy and reasonableness while performing analysis of trends as appropriate.
Reviews final settled cost reports to determine if the next steps are appropriate.
Prepares position papers for Medicare/Medicaid appeals including responses to the Medicare Fiscal Intermediary.
Documents and defends adequacy of reserves for all open Medicare/Medicaid cost reports.
Reviews and maintains processes for completion of required documentation to support the ability to claim accurate reimbursement in the areas of wage index, DSH, and bad debts.
Maintains knowledge of changing regulations through such means as reading needed regulations, newsletters, and continuing education workshops.
Oversees assigned department or functional area to ensure it is performing effectively, which may include but not limited to, hiring and training team members, creating and implementing business strategies, managing performance of team members, and delegating tasks.
May perform additional duties as assigned.

Minimum Qualifications

Experience - Seven years of reimbursement experience in a healthcare setting to include at least two years in a management position.

Education - Bachelors Degree in Business Administration or Accounting.

Preferred Qualifications

Amendments & Appeals: Identifies amendment opportunities; manages appeal timelines; documents and defends reserves on open reports; prepares the monthly journal entries for the cost report reserves.

End-to-End Medicare cost reporting: Expertise including preparation, amendments, reopening's, settlements, and audit/appeals interaction.

Audits & Interaction: Direct experience collaborating with Medicare auditors, including issue resolution, audit responses, and negotiating findings.

Vendor Coordination: Manages external reimbursement vendors (scope definition, data exchanges, and QA of workpapers/deliverables).

Provider Enrollment: Hands-on with Medicare provider enrollment, modifications, revalidations, and coordination to secure timely effective dates aligned to cost reporting would be a plus.

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV

Reimbursement Manager

Medicare Cost Reporting

Inova

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