Reimbursement Director

3 months ago

Gainesville, United States Northeast Georgia Health System, Inc Full time

Job Category:

Accounting & Finance, Executive Leadership

Work Shift/Schedule:

8 Hr Evening - Morning

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.



About the Role:

Job Summary

Under the general direction of the Executive Director, Corporate Controller, responsible for the coordination of all CMS reporting requirements including oversite of the GME reporting functions. In addition, responsible for the administration of the charge description master and revenue forecasting for both budget and month-end close. Will serve as the organization expert on CMS regulatory changes and will make recommendations to senior management related to proposed changes.  Takes the lead for the organization's Accounts Receivable review and analysis 



Minimum Job Qualifications

  • Licensure or other certifications:

  • Educational Requirements: Bachelors Degree in Business Administration, Finance, Accounting or other related area

  • Minimum Experience: Minimum five (5) to seven (7) years relevant work experience in healthcare financial management including revenue modeling and CMS cost reporting activities

  • Other:



Preferred Job Qualifications

  • Preferred Licensure or other certifications:

  • Preferred Educational Requirements: Masters degree or CPA

  • Preferred Experience: Operational experience as a Director in a health system

  • Other:



Job Specific and Unique Knowledge, Skills and Abilities

  • Ability to research complex coding, reimbursement and regulatory requirements

  • Knowledge of clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology

  • Must have a good understanding of the CDM and its relationship to related areas such as the General Ledger, Cost Accounting, Inventory, Productivity, Cost Reporting and Budget

  • Extensive knowledge of CPT/HCPCS, UB-92 Revenue Coding, modifiers, billing regulations, DRGs and APCs

  • Understanding of Graduate Medical Education and health care financing issues

  • Possess effective time management skills to permit handling of a large workload

  • Ability to multi-task and work under aggressive deadlines

  • Ability to understand and analyze payor contracts/regulations and model net revenue impacts based on reimbursement and coding guidelines



Essential Tasks and 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 the 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.

  • Collaborate with managerial and supervisory staff to ensure regulatory billing with correct coding on accounts.

  • Maintain 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.

  • Monitor compliance with corporate, federal, and state guidelines.

  • Oversees all cost reporting to CMS for funding for GME programs in cooperation with the Finance Department.

  • Work 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.

  • Remain 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.



Physical Demands

  • Weight Lifted: Up to 20lbs, Occasionally 0-30%

  • Weight Carried: Up to 20lbs, Occasionally 0-30%

  • Vision: Moderate, Constantly 66-100%

  • Kneeling/Stooping/Bending: Occasionally 0-30%

  • Standing/Walking: Occasionally 0-30%

  • Pushing/Pulling: Occasionally 0-30%

  • Intensity of Work: Constantly 66-100%

  • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 


NGHS: Opportunities start here.

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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