Reimbursement Director
6 days ago
Under the general direction of the Executive Director, Corporate Controller, we are seeking a highly skilled Reimbursement Director to coordinate all CMS reporting requirements, including oversight of the GME reporting functions. This individual will also be responsible for the administration of the charge description master and revenue forecasting for both budget and month-end close.
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
- 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
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.
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