Senior Program Manager - Reimbursement - Acute

UHS•King of Prussia, PA

About The Position

UHS is a dynamic organization driven by a passion for healthcare, seeking talented individuals to contribute their expertise and pursue rewarding careers. As a leader in acute care and behavioral health, UHS provides high-quality care to over 3 million patients annually across its national network of facilities. The UHS Corporate Reimbursement Department is hiring a Program Manager - Reimbursement - Acute to complete Medicare and Medicaid fee-for-service reimbursement functions, including cost report preparation, for multiple assigned hospitals or other UHS entities. These entities have complex reimbursement environments and significantly impact UHS financial statements.

Requirements

Bachelor's degree with 8 - 10 years' experience with expert knowledge of cost reporting applications and concepts
Comprehensive knowledge of Medicare prospective payment systems including Inpatient Acute DRGs, Outpatient APCs, Rehabilitation CMGs and Psychiatric IPF-PPS
Thorough understanding of Medicare statutes, regulations and administrative rules and their related legislative and regulatory processes. Specific knowledge of Graduate Medicare Education (GME) and Indirect Medical Education (IME) reimbursement
Thorough understanding of Medicaid supplemental payment concepts including state directed payments and related provider tax assessments
Thorough understanding Medicare alternate payment concepts with a particular focus on Bundled Payments
Thorough understanding of Quality based Medicare reimbursement concepts (i.e. Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc.)
Intermediate-to-Advanced level knowledge of Microsoft Excel
Familiarity with Mckesson G/L and Siemens Invision
Proficiency in HFS cost report software (or its equivalent)

Responsibilities

Complete Medicare and Medicaid cost report submissions for assigned hospitals or other UHS entities and related desk review and audit activity (including wage index reviews or other Medicare/Medicaid reimbursement activity) for multiple facilities with complex reimbursement environments and that have a high level of financial statement impact
Provide independent on-going hospital reimbursement consulting services (e.g. compliance, billing, financial pro forma analysis) to UHS corporate business office, regional finance and to hospital executive staff and other UHS entities. Independently handles complex reimbursement projects and assignments
Oversee, coordinate and develop the reimbursement aspects of all UHS acute care hospital Medicare alternate payment methodology activity with a focus on Bundled Payments., as applicable
Oversee, coordinate and develop the reimbursement aspects of all UHS acute care hospital Medicare quality based payment methodology activity including but not limited to Value-Based Purchasing, Hospital Acquired Conditions, Excess Readmissions, etc., as applicable
Provide applicable Medicare and Medicaid contractual models, related reimbursement factors and other necessary data. Review these models for compliance and accuracy
Participate in the oversight, development and maintenance of Medicaid supplemental payment (UPL/SDP) and state Medicaid DSH programs for assigned facilities