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Posted: 04-Feb-25
Location: Irving, Texas
Categories:
Internal Number: 248771
Summary:
The primary purpose of the Reimbursement Manager is to ensure proper payments are received from Third Party programs and proper accounting of such programs is maintained. This will be accomplished through completion and review of monthly contractual related income statement and balance sheet accounts and proper filing, audit and settlement of cost reports. The System Reimbursement Manager is responsible for the reimbursement function of multiple facilities. The complexity of the facilities may include acute care, rehabilitation unit, psychiatric unit, skilled nursing facility, medical education, End Stage Renal Disease, Organ Transplant and Disproportionate Share. The System Reimbursement Manager spends a significant amount of time supporting the Corporate Reimbursement Department, on projects as needed. The needs could include and are not limited to regulatory analysis, financial analysis, system-wide reopening or reporting issues. This position requires diligent values of integrity and compliance with all applicable Regulations
Responsibilities:
- Prepare and review monthly contractual allowance journal entries and supporting calculations and responsible for proper balances in associated income statement and balance sheet accounts, for multiple facilities
- Scope of accounting responsibility includes Medicare, Medicaid, USFHP, CHAMPUS, Blue Cross, Worker's Compensation and Managed Care
- Analyze monthly contractual allowance variances, providing detailed explanations for significant fluctuations to Hospital Administration for use during close meetings
- Maintain current, correct account analysis' related to program Income Statement and Balance Sheet accounts
- Ensure monthly reports are prepared timely and accurately by supporting departmental Associates
- Prepare final hospital and home office cost reports, completing comparative analysis of the cost report versus the financial statement and compliance checklist prior to submission, for multiple facilities
- Ensure Medicare, Medicaid and CHAMPUS cost reports are submitted by due dates to prevent loss of reimbursement to the facilities
- Identify and pursue proper reimbursement methodologies in an effort to receive all reimbursement due based upon Medicare, Medicaid and CHAMPUS Regulations
- Coordinate the Medicare Field Audits, ensuring complete, proper and timely information is provided and audit adjustments are reviewed prior to issuance of the settlement
- Errors found must be communicated in writing to the Auditors during the audit, to ensure proper settlement and issuance of the Notice of Program Reimbursement
- Prepare audit adjustment analysis to determine reimbursement impact of adjustments to as filed report
- Act as a liaison to the External Financial Auditors for both the interim and final audits, for multiple facilities
- Review settled cost reports prior to final reopening deadlines to ensure the reports were appropriately settled
- Prepare and submit cost report reopening requests to obtain additional reimbursement due and otherwise make requests for corrections as appropriate
- Prepare and submit appeals and subsequent position papers to appeal inappropriate settlements with the PRRB, for assigned facilities
- Assist in preparation of Social Accountability and Community Needs reports required as part of annual budget process
- Respond to requests from Hospital Administration and other internal and hospital departments in areas where reimbursement knowledge is required
- Analyze and inform Hospital Administration of financial impact of operational decisions, as requested
- This may include preparation of pro-forma analysis and due diligence for new and existing business opportunities and informing Management and Hospital Administration of proposed/final rules and Regulations, which could impact the hospitals' operations
- Assist in maintenance of rate tables for Medicare, Traditional Medicaid and CHAMPUS in an effort to ensure proper payments are received
- Monitor interim payment rates and work with the Intermediary to ensure proper payments are being made
- Participate on the performance initiative to track, review and reduce denials
- Assist with contract rate issues as requested
- Collaborate on cross-functional teams to address System standardization needs of processes where reimbursement expertise is required
- Assist in authoring thorough, accurate policies and procedures for standardized and transparent processes
- Assist Accounting and Business Office departments with the cash reconciliation process for settlements and interim payments
- This includes identifying and communicating errors or issues found to these departments
- Maintain knowledge of current trends and developments in the field by reading appropriate books, journals, and attending related seminars and conferences
- Actively participate as a member in HFMA as a representative of CHRISTUS Health
- Assist Director and Senior Managers of Reimbursement Department including education, annual reimbursement conference and other projects
Requirements:
- Bachelor's Degree
Work Type:
Full Time
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