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Reimbursement Program Manager
4 months ago
This is an onsite position at All Chrildren's Hospital, St. Petersburg, FL
The Johns Hopkins All Children's Hospital (JHACH) Reimbursement Program Manager purpose is to serve as the primary expert in state and federal funding programs, with a specific emphasis on, but not limited to, the State of Florida's Medicaid program. The incumbent will manage reimbursement reporting, analysis, and performance improvement opportunities.
This role serves as an expert in assessing supplemental funding/reimbursement performance and strategies. The incumbent will provide expertise and insight to JHACH and JH executive leaders on payment programs such as the Specialty Outlier Payment, the Special Children's Supplement Program, the Directed Payment Program, Disproportionate Share Hospital, Lower Income Payment, Graduate Medical Education, Indirect Medical Education, and other programs as they arise. The role requires a strategic thinker with a high-degree of initiative and action-orientation, and must stay informed of changes in local and federal guidelines.
The incumbent will be responsible for delivering or working with JHACH and Johns Hopkins Health System resources to support the preparation, submission, and settlements of all required cost reports for reimbursement from federal and state programs, such as Medicaid, Medicare, and FHURS (Florida Hospital Uniform Reporting System). As appropriate, the incumbent will lead or represent JHACH with external consultants, agencies and stakeholders, and will develop appropriate relationships with industry experts to broaden our knowledge and strategic insight.
The incumbent will prepare financial models under different scenarios, including the impact of new regulations or new funding mechanisms on the organization's strategic goals. The leader will work in a highly matrixed environment, and will keep leadership informed of opportunities and potential challenges, and will be adept at simplifying complex topics and data.
Key partners and contributors: JHACH Chief Financial Officer, finance, revenue cycle, managed care, financial innovation, decision support; JHACH Physicians enterprise leadership team; All Children's Research Institute leaders; JHHS VP of Revenue & Reimbursement and team; JHACH President, JHACH VP of Government Affairs; and relevant external consultants.
QUALIFICATIONS:
- Bachelor's degree in Accounting or Finance or related field
- 5+ years of experience in Medicare and Medicaid reimbursement and cost reporting preparation
- Demonstrated knowledge of experience in Florida Medicaid and the supplemental funding pools (dollars outside of Fee for Service), strongly preferred
- Familiarity with 340B programs, managed care relationships, and standard revenue cycle practices strongly preferred
- 2 years of experience in a leadership role preferred
- Basic understanding of Generally Accepted Accounting Principles (GAAP) and their application
- Experience with healthcare and non-for-profit accounting principles and procedures
- Ability to interpret an analyze regulations issued by Centers for Medicare and Medicaid Services (CMS)
- Proficient in the use of a personal computer and software applications (e.g. Microsoft, Word, Excel, PowerPoint, etc.) to include cost reporting and graduate medical education software
KEY ACCOUNTABILITIES:
- Assesses current performance and establishes quarterly/annual goals and work plans that matures the organization's reimbursement strategy.
- Manages the process for the collection of data and creation of supporting documentation for the preparation and submission of the Medicare and Medicaid cost reports for submission to the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Administration (AHCA) for government reimbursement of costs. Works in conjunction with members of the JH Revenue & Reimbursement department.
- Works with appropriate parties to coordinate the completion and submission of the initial application, performance report, and reconciliation application for the Children's Hospitals Graduate Medical Education (CHGME) program for government reimbursement of graduate medical education costs.
- Serves as a liaison to contracted government auditors in the audit of submitted cost reports to provide data requests, supporting documentation, and guidance.
- Organizes the completion and submission of annual surveys and State agency reports such as Disproportionate Share (DSH), Low-Income Pool (LIP) and Florida Hospital Uniform Reporting System (FHURS).
- Analyzes impact of federal regulation changes to Medicare and Medicaid, as well as State of Florida legislature policy changes and communicates those impacts to leadership.
- Assists finance and accounting staff to record accounting entries related to DSH, LIP, Education Revenues, and cost report settlements.
- Provides training and coaching to leaders and stakeholders to develop internal expertise. Keeps executive leadership informed of potential/pending changes and models the impact to JHACH.
- Actively broadens knowledge and develops relationships with industry peers and local colleagues to stay informed of best practices.
- Works closely with the JHACH Financial Planning & Analysis team on the annual operational budget, prospectively modeling reimbursement for the forthcoming year. Assists in the tracking and reporting of variances from plan throughout the year.
- Manages relationship and directs relevant JHACH third-party consultants/advisors. Regularly evaluates the scope of external relationships for improvements required or expense reduction opportunities.
- Serves as a liaison with Johns Hopkins Health System office of Revenue Management and Reimbursement and team to coordinate ownership of various tasks.
- Responsible for the coordination of activities and ensures continual compliance with local and national regulatory standards (i.e. TJC, CMS, AHCA, etc.).
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.
