Reimbursement Director

5 days ago

Gainesville, Florida, United States Northeast Georgia Health System Full time
Job Summary

Under the general direction of the Executive Director, Corporate Controller, this role is responsible for coordinating all CMS reporting requirements, including oversight of GME reporting functions. Additionally, the incumbent will administer the charge description master and revenue forecasting for both budget and month-end close. The ideal candidate will serve as the organization's expert on CMS regulatory changes and provide recommendations to senior management related to proposed changes. This role will also take the lead for the organization's Accounts Receivable review and analysis.

Key Responsibilities
  • Oversight of Charge Description Master functions and reimbursement analysis.
  • Supervision and coordination of Charge-master management functions in researching coding and billing guidelines, researching insurance contracts, and updating hospital Charge-master.
  • Works with revenue-producing departments to ensure the ongoing coordinated consistency of the Charge-master, including accurate descriptions, coding, additions, deletions, pricing, charging methodology, and any other changes.
  • Collaborates with managerial and supervisory staff to ensure regulatory billing with correct coding on accounts.
  • Maintains a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist the health system in cash collection while accurately complying with billing guidelines.
  • Monitors compliance with corporate, federal, and state guidelines.
  • Oversees all cost reporting to CMS for funding for GME programs in cooperation with the Finance Department.
  • Works with Finance to perform applicable analyses to understand net revenue effect of proposed Charge-master changes.
  • Performs analysis, identifies trends, validation of compliance as related to fiscal activities generating additional revenue, reducing bad debt expense, and charity write-offs and overall expense reduction.
  • Remains current with updated coding and billing regulations.
  • Prepares, monitors, and files Medicare and Medicaid Cost Reports assuring maximization of reimbursement from third-party payors.
  • Responds to surveys affecting Medicare and Medicaid rate revisions, interim payments, and hospital-based physician arrangements.
  • Monitors changes and proposed changes to Medicare and Medicaid regulations and determines the financial effect of these changes on the organization.
  • Coordinates financial audits conducted by CMS, DCH, and other governmental intermediaries on prior year's cost reports and surveys.
  • Provides management for Indigent Care Trust Fund processes and reporting.
Requirements
  • Bachelor's Degree in Business Administration, Finance, Accounting, or other related area.
  • Minimum five (5) to seven (7) years relevant work experience in healthcare financial management, including revenue modeling and CMS cost reporting activities.
  • Operational experience as a Director in a health system.
Preferred Qualifications
  • Masters degree or CPA.
  • Knowledge of clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology.
Working at NGHS

At Northeast Georgia Health System, we value our employees and strive to create a work environment that is supportive, inclusive, and rewarding. We offer competitive compensation and benefits, as well as opportunities for professional growth and development.

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