Reimbursement Manager - Reimbursement and Revenue Integrity - FT - Days - MHS

Memorial Healthcare

1d•Onsite

About The Position

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. The Reimbursement Manager completes tasks as assigned to assist Directors and the Vice President of Reimbursement & Revenue Integrity with: Medicare and Champus cost reporting and audits, interim rate and settlement calculations, Medicaid waiver reports, maintenance of net revenue preparation and analysis, and various other projects.

Requirements

Bachelors (Required)
Five (5) years of progressively responsible experience in hospital reimbursement operations, audit or consulting including projects specifically related to Medicare and Medicaid reimbursement.
Critical thinking skills
Effective communication
Decisive judgment
Ability to build and foster positive relationships
Ability to lead others and take appropriate action when required
Thorough knowledge of Medicare, Medicaid and Champus rules and regulations
Thorough knowledge of Third party audit techniques
Proficient in Microsoft Office products
Proficient in Cost Reporting Software

Responsibilities

Stay current with the Medicare/Medicaid and other third party payor regulations and determining the impact to the System.
Monitor and research state and federal requirements to ensure adequate understanding of compliance issues and opportunities and to ensure timely communication to all affected parties.
Participate in the preparation, input, and analysis of the annual Medicare, Medicaid and Champus cost reports.
Provide analytical support for the timely and accurate preparation of the cost reports, including information for the preparation of the cost reports, audit schedules, and account reconciliations.
Monitor and maintain various cost report statistics such as time studies, meal count and square footage.
Coordinate outside audit responses and efforts of outside consultants responsible for Medicare Disproportionate Share Hospital (DSH) payments, Medicare Bad Debt, Medicare Appeals, and review of Medicare Indirect Medical Education (IME) and Graduate Medical Education (GME) payments.
Develop responses to Medicare reviews including Wage Index and Occupational Mix Survey.
Compile and analyze Medicaid DSH and Low Income Pool (LIP) supporting schedules and final reports.
Draft related audit responses.
Develop strategic plans for future payment enhancements.
Prepare monthly close and annual financial statement documents related to net revenue and supports annual accounting audit of same.
Function as primary backup to the Directors in the monthly close process.
Maintains roll forward schedule of third-party settlement balances and their application as part of the monthly close process and annual financial audit.
Review and approval of outside consultant invoices for Medicare Transfer reimbursement improvements.