Director, Medicare/Medicaid Reimb

Orlando Health•Orlando, FL

About The Position

Responsible for oversight of financial analysis, processes, accounting, and reporting for reimbursement activities for system hospitals. Maintain knowledge of current regulations and assure the company is in compliance with them. Provide executives education on IME, GME, Provider Based rules, rural status. Provide system with ongoing financial oversight in reimbursement. Review Medicare/Medicaid cost reports with emphasis on accurate reimbursement to hospital. Review staff completion of all time studies, rotation schedules, statistics and bad debt logs, throughout the fiscal year that are used to complete the annual cost reports. Identifies opportunities to optimize reimbursement including capturing 340B discounts, combining or separating provider numbers. Review monthly close for third party settlement accounts and make sure each hospital is accurately reserved. Review staff responses to Medicare/Medicaid Intermediary to settle various cost report audits each year. Review the Champus Capital and GME Cost report for each hospital. Review year end Medicare Settlement schedules to maintain proper third-party liability accounts. Review third party reimbursement packages for external audit each year. Maintains compliance with all Orlando Health policies and procedures. Monitor wage index areas for geographical reclassifications to enhance reimbursement to each hospital. Develop Reimbursement skills in staff. Review annual IPPS, OPPS rules to find reimbursement opportunities for the system. Provide executive summary of changes in reimbursement impact to system to senior leaders. Review LIP, and DPP schedule prepared by staff, ensure accuracy to achieve maximum allowable reimbursement. Review provider-based attestations for OP centers created with expansion of the system. Participates with other functional leaders on strategic initiatives to incorporate regulatory reimbursement concerns.

Requirements

Bachelor’s degree in Accounting, Finance or Business Administration.
CPA required.
Ten (10) plus years in a leadership role in a complex health system.

Responsibilities

Oversight of financial analysis, processes, accounting, and reporting for reimbursement activities for system hospitals.
Maintain knowledge of current regulations and assure the company is in compliance with them.
Provide executives education on IME, GME, Provider Based rules, rural status.
Provide system with ongoing financial oversight in reimbursement.
Review Medicare/Medicaid cost reports with emphasis on accurate reimbursement to hospital.
Review staff completion of all time studies, rotation schedules, statistics and bad debt logs, throughout the fiscal year that are used to complete the annual cost reports.
Identifies opportunities to optimize reimbursement including capturing 340B discounts, combining or separating provider numbers.
Review monthly close for third party settlement accounts and make sure each hospital is accurately reserved.
Review staff responses to Medicare/Medicaid Intermediary to settle various cost report audits each year.
Review the Champus Capital and GME Cost report for each hospital.
Review year end Medicare Settlement schedules to maintain proper third-party liability accounts.
Review third party reimbursement packages for external audit each year.
Maintains compliance with all Orlando Health policies and procedures.
Monitor wage index areas for geographical reclassifications to enhance reimbursement to each hospital.
Develop Reimbursement skills in staff.
Review annual IPPS, OPPS rules to find reimbursement opportunities for the system.
Provide executive summary of changes in reimbursement impact to system to senior leaders.
Review LIP, and DPP schedule prepared by staff, ensure accuracy to achieve maximum allowable reimbursement.
Review provider-based attestations for OP centers created with expansion of the system.
Participates with other functional leaders on strategic initiatives to incorporate regulatory reimbursement concerns.