The Reimbursement Manager is primarily responsible for ensuring the timely filing of third-party cost reports related to the Medicare, Medicaid/MCO, and Champus programs within established due dates. This shall include both the annual required filing and any interim/mid-year reports for internal modeling and review. The Reimbursement Manager is also responsible for coordinating data gathering to meet requests from auditors and other third-parties, review of proposed audit adjustments, and preparation of any Management/Corporate response to audits/reviews, in conjunction with the Director and external consultants. This position will also be responsible for leading and supervising a team of analysts, and to ensure that the monthly close and balance sheet reconciliation processes [for settlement and related accounts] are properly executed and maintained. The Reimbursement Manager will also be required to handle/oversee other functions as needed, including (but not limited to) proforma/cost analyses, managed care contracting, special projects, as well as research and analysis.
The principal goal of the Corporation’s Reimbursement Team shall be timely execution of data gathering, preparation, review, and issuance of required third-party cost reports, with excellence and reliability. Further, the Team shall have the goal of providing relevant financial, reimbursement, and operational data for optimal decision making. Finally, the Reimbursement Team shall consistently add value to the Corporation through its efforts to enhance net revenue.
This candidate must have a Bachelor's degree in finance, accounting or business administration, or any comparable level of education, and experience preferably in a hospital setting. Master’s degree or relevant certification [e.g. CPA] is a plus.
The successful candidate should have a minimum of 5 to 10 years of relevant experience in a healthcare finance setting, and should also have demonstrated expertise and knowledge in Medicare and Medicaid reimbursement regulations, including DSH, IME/GME, CAH, wage index and related topics. Excellent computer skills [MS Excel/Office], and communication skills are a must. desirable.
Required Skills, Knowledge, and Abilities
· Solid working knowledge of Medicare and Medicaid Regulations
· Experience in preparation, review, and appeal of third-party cost reports
· Knowledge of MAC/MCO/Agency operations; diplomatic skills and effective communications with auditors
· Strong analytical and quantitative skills
· Expertise in Excel and related computer applications
· Excellent critical thinking skills.
· Ability to multitask and prioritize assignments while producing high quality work in a demanding, fast-paced environment
· Excellent verbal and written communication, teamwork, and relationship-building skills.
· Effective presentation skills, along with comfort level in conversing and interacting with Corporate leadership
· Excellent skills in managing workload timely and efficiently
· Demonstrated leadership and ability to lead, supervise, and produce excellent results from team
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