Manager Reimbursement - Decision Support in Santa Fe, NM

Summary:

This position has responsibility for all regulatory and accounting aspects of Medicare and Medicaid third party reimbursement as well as performing analysis of managed care contracts to ensure appropriate and optimized reimbursement. This position will also be responsible for analysis of self-pay accounts, analysis of all monthly third party utilization activity, including Medicare and Medicaid, perform all third party rate analysis, and perform all third party reimbursement improvement analysis and the related accounting.

This position is also responsible for updating appropriate hospital clinical and administrative managers of the impact of regulatory changes for Medicare, Medicaid, Indian Health, New Mexico Workers Compensation and CHAMPUS or contractual changes for managed care and commercial accounts as well as research any reimbursement related issues that may be posed from these hospital clinical and administrative managers as appropriate. This position oversees and manages the loading and maintenance of contracts and rate tables in Quadramed QCM.

This position oversees and verifies the accuracy of payments and adjustments for all government and commercial payers. The Manager of Reimbursement is responsible for ensuring the charge master is maintained to include that all possible charges are active and prices are appropriately set. This position will be principally responsible for the above noted services for the hospital but also will work with the affiliated facilities as appropriate.

Responsibilities:

• Oversees the analysis of Managed Care and Reimbursement Issues, including but not limited to:
  • Supports patient financial services and accounting systems
  • Supports payer contract negotiation and interpretation
  • Assists in the analysis of proper payment by government, managed care or commercial contractors which includes maintaining contracts and rate tables in QCM
  • Analysis of payer / patient utilization as related to general trending analysis
• Responsible for preparation and filing of Medicare / Medicaid / CHAMPUS and New Mexico Workers Compensation cost reports, including proper work paper documentation and data submission.
• Responsible for ensuring appropriate reimbursement for hospital acute services and related exempt units for all government, managed care or commercial payers
• Responsible for timely and appropriate communication with Medicare and Medicaid fiscal intermediaries, including response to prior year filed cost report re-openings, appeals and/or audits
• Responsible for analysis and communication to upper management, and appropriate clinical and administrative management of changes in Medicare, Medicaid and other payer payment methodologies and/or regulatory changes including, but not limited to distribution of electronic or paper copies or training on said payer payment methodology and regulatory changes to appropriate hospital personnel
• Assists with implementation and testing of payment changes and their effect on current net revenues and budgets
• Strategize ways to mitigate negative impact of potential payer payment methodologies or regulatory changes to net revenue or operations. Includes researching problems related to questions from various hospital personnel on changes to regulations or payer payment methodologies related to payment or potential increases / decreased reimbursement
• Facilitates development of internal procedural and automated reporting systems designed to facilitate financial analysis and financial projections related to contractual allowance/bad debt and other net revenue model scenarios
• Participates in revenue, contractual allowance and bad debt budget development, and prepares month-end budge to actual variance analysis related to same
• Calculates month-end contractual allowance and bad debt allowance based on changes in accounts receivable aging and other related patient accounting issues. Analyzes changes during month, and communicates problems / issues that arise in analysis to appropriate department and manager
• Responsible for preparation of appropriate financial statement components related to third party reimbursement, accounts receivable and bad debt allowance as well as maintenance of all current year and prior year open general ledger third party settlement accounts
• Responsible for preparation and analysis of year-end financial audit work papers related to all contractual / bad debt / third party general ledger accounts
• Responsible for providing cash flow projections, especially related to Medicare and Medicaid billing and collections. Assists with csh flow projections related to other payer sources.
• Supervises the Charge Master Coordinator and Clinical Decision Support analyst
• Responsible for completeness and accuracy of charge master
• Responsible for ensuring all revenue generating departments are reconciling charges on a daily basis
• Consistently meets negotiated timeframes set by supervisor and other members of upper management

Requirements:

Education:

• Bachelor’s degree in Accounting or Finance required. Master’s degree in Business is preferred.

Experience:

• Seven years of third party reimbursement experience in a hospital setting. Must have completed both Medicare and Medicaid hospital cost report preparation for at lest 5 years. Must have prepared and/or reviewed month-end contractual allowance/bad debt analysis. Must have worked closely with fiscal intermediary in resolving questions related to prior year and current year filed cost reports. Experience working with Patient Financial Services, Health Information Management, and Healthcare Advocacy Groups is highly desirable.
• Demonstrated professional competency skills in management. Must demonstrate strong verbal and written skills, as well as leadership skills necessary to promote a spirit of cooperation, teamwork, and customer service. Must be proficient in spreadsheet and word processing programs. Must demonstrate strong analytical and problem-solving skills. Must have detailed experience in handling Medicare, Medicaid, CHAMPUS and Indian Health third party reimbursement issues including cost report preparation, contractual accounting, and handling fiscal intermediary and financial statement audits as they relate to third party reimbursement. Must have experience in dealing with managed care contract issues as they relate to third party reimbursement.

Certifications, Registrations, or Licenses:

• Certified Public Account (CPA) is preferred.

Work Schedule:

MULTIPLE SHIFTS AVAILABLE

Work Type:

Full Time