Reimbursement Manager
4 weeks ago
Where compassion meets innovation and technology and our employees are family.
JD Attached*
General Purpose of Job:
This role is critical to the success of the Revenue Cycle Support Services department and requires the individual to be skilled at utilizing a collaborative approach, work effectively and efficiently, working cross-functionally with all Driscoll Health System operational areas, helping to get consensus across operational areas, and helping to ensure that Driscoll Health System maintains compliance across the organization. This individual should demonstrate strong analytical skills as it relates to organizational activities and revenue. This individual will manage and supervise the reimbursement activities of the Revenue Cycle Support Services department. This individual will assist with the hospital's financial accounting of monthly contractual, third party reserves, annual revenue and contractual budget, and adhoc analysis. They will also assist with the analysis, preparation, and submission of System government report to the Texas Health and Human Services Commission, Centers for Medicare and Medicaid, HRSA, Third Party auditors for Supplemental govt. programs and other agencies as necessary. The role includes coordination of all Cost Reporting requirements, Waiver Programs, Uncompensated Care Programs, Disproportionate Share Programs, Children’s Hospital Graduate Medical Education Program, Grant opportunities, Surveys, Schedule H of the 990 Tax Return, Physician Time Studies, and more.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.
Maintain utmost level of confidentiality at all times.Adhere to system policies and procedures.Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.Provide direction and supervision to Reimbursement staff, especially on Medicare cost report issues. Analyze and provide trending data with conclusions in an Executive Summary for senior management presentation. Prepares SMS ad hoc reports and analyzes data using Monarch, Excel, Access and Word.Create a system (including uncompensated care analyses) for reporting the “community benefit” of the hospital to support continued IRS non-profit status.Prepare sophisticated calculations for contractual allowances and bad debt reserve for the monthly journal entries to accurately state the financial position of the hospital. Provide Information Technology with the factors necessary to compute Medicare and Medicaid inpatient contractual allowances at time of billing.Serve as primary Reimbursement interface with external auditors for contractual allowances and bad debts.Manage the preparation of the net revenue portion of the Hospital’s annual financial plan. Prepare presentation materials for distribution to Hospital leadership.Continuously monitor actual net revenue results compared to plan to ensure hospital objectives are met. Calculate the impact that rate increases and other factors have on net revenue.Establishes and maintains collaborative relationships in order to engage other team members and/or other departments as necessary to mitigate issues and reach resolutionsRead Medicare and Medicaid regulations and understand the impact to the Hospital. Present interpretations to executive management.Serves as the lead subject matter expert in development of business intelligence tools that support government programsProvide direction and supervision to Reimbursement staff, especially on Medicare cost report issues. Promote teamwork and a positive attitude within the department.Serves on project teams performing tasks assigned by the Director. This role will lead and monitor project teams under the Director’s supervision. Routinely provides project updates to appropriate individuals. Examples include new providers included in time studies, auditsEvaluate new products and emerging technologies regarding their suitability within the framework of the current environment.Supervises requirements for external audits which may include: Cost Reports, DSH, UC, 1115 Waiver, CHGME, Grants, etc.Oversee and coordinate communications with administration, legal, operations, and financial representatives for issues, updates, and reviews related to Supplemental Programs. Participates in pediatric related collaborative (example: CHAT, CHA, etc.) that benefit the organization.Negotiates single patient agreements with non-contracted payers for hospital services and/or physician services.Provides Director with payer report cards on a quarterly basis for contracted insurance companies.Participates in the development of annual budget and assists in developing revenue goals, strategies, activity plans and objectives.Manages multiple on‐going projects and preparation of presentations of findings and recommendationsPerform other related revenue cycle dutiesEducation and/or Experience:
Bachelor’s degree in Business Management or Computer Information Systems is required. Master’s degree preferred.Required: Medicare and Medicaid Cost Reporting experienceKnowledge of Medicare and Medicaid Rules (both CMS and Texas State Medicaid)Knowledge of HRSA, Uncompensated Care, and Disproportionate Share RulesProficiency in Microsoft Excel, PowerPoint, and WordPrior experience with EPIC, 3M, ICD-10, or Midas is a plus5+ years of experience in a hospital or healthcare setting requiredStrong oral and written communication skillsStrong organizational skillsAbility to multi-task and work on multiple projects simultaneously-
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