Date Posted: 9/13/2022 10:36:27 AM
Location: Sheridan, MI
Job Type: Full Time
Salary (USD): $60,000 - $60,000
The position shall be responsible for the day-to-day operational management of the reimbursement. Supervises the preparation of Medicare, Medicaid, Blue Cross, and related reimbursement studies and cost reports on an interim and fiscal year basis. Responsible for the proper compliance with all provider regulations and laws governing the preparation of cost reports and other such submissions. Supervises the necessary calculations to properly record the contractual adjustments for Medicare, Medicaid, Managed Care Payors, and any other payors assigned; or the review of calculations performed by others. Review or calculation of appropriate bad debt / charity reserve amount (allowance for bad debt). Responsible for the reasonable explanation of deduction variances as well as net revenue variance from budgeted levels on a monthly basis. The position is also responsible for the calculation of the deduction from revenue budget for the hospital. Review reimbursement related regulatory changes and assists Senior Management in understanding and evaluating the impact of these changes. Communicates reimbursement related information to appropriate individuals throughout the organization and understands the concept of a full service reimbursement department. This position will be responsible for the review, updating and subsequent implementation of the official Charge Master.
• Responsible for data collection and analysis for the reimbursement department.
• Involved in aspects of the year end Cost Reporting filing and preparations.
• Directly responsible for collecting, recording and reviewing all documentation required by CMS and State reporting. (Cost Report, Bad Debts and DSH)
• Responsible for collecting, recording and reviewing, and reconciling all Physician Time Studies.
• Actively participate and contribute to ad hoc revenue analysis projects.
• Using knowledge of Medicare and Medicaid government regulations, complete statistical and financial modeling to produce cost reports to ensure all reimbursement are captured.
• Prepare analysis of new developments and/or proposals in the reimbursement field to determine financial impact.
• Gather data and complete required analysis at the request of outside audit staff during audits by Medicare, Medicaid, and Blue Cross and report the impact of audit to management.
• Responsible for audit and review of the Hospital Charge Master/ Clinics Fee Schedule, formulas and gross patient charge amounts. CMS online requirements for transparency.
• Knowledge of Medicare and Medicaid regulations regarding CAH and Provider-based RHC billing and Cost Report filing. Knowledge of CMS (PS & R) The Provider Statistical & Reimbursement Reporting System and Michigan’s CHAMPS Facility Settlement System.
• PAMA laws regarding effects to CAH Hospital and implementation of processes.
• Maintain and negotiate Third party payer contracts. Maintain contract Management.
• Bachelor’s degree required. Bachelor’s degree in Accounting or Finance preferred.
• 2-5 years related work experience required.
• Advanced Skills with Microsoft applications which may include Outlook, Word, Excel, or Access. Other Ad Hoc reporting skills. May produce complex documents, perform analysis and maintain databases. Ability to prepare and/or develop financial and statistical reports for reporting and analysis of reimbursement.
• Knowledge of third party reimbursement rules and regulations along with reporting procedures and requirements.