MGR REIMBURSEMENT
Apply NowCompany: H. Lee Moffitt Cancer Center
Location: Tampa, FL 33647
Description:
Position Highlights:
The Ideal Candidate:
Responsibilities or Essential Functions:
Credentials and Experience:
- The Manager of Reimbursement is responsible for the Cancer Center's Medicare and Medicaid reimbursement matters.
- This includes the annual and interim third party cost report completion and monthly contractual allowances and settlement adjustments.
- The Manager is responsible for achieving accurate third-party reimbursement.
- Moffitt is a cost-based PPS exempt Cancer Center with significant cost report settlement activities.
- This position serves as an expert resource for the Cancer Center in the areas of Medicare and Medicaid regulatory/settlement matters.
The Ideal Candidate:
- The ideal candidate will have Healthcare financial experience, including hospital reimbursement and experience with cost reporting.
- The ideal candidate will have experience with patient billing and general ledger software and have experience with Medicare auditors and defending proposed adjustments
Responsibilities or Essential Functions:
- Prepares and files Medicare Cost Reports ensuring strict compliance with all Medicare regulations, policies, procedures and guidelines
- Analyze cost report results to ensure the most appropriate reimbursement considering Moffitt's cost based/PPS
exempt status. - Maintaining and reviewing for reasonableness all cost allocation statistics; recommend changes as necessary
- Responds to third party auditors, Medicare Administrative Contractor (MAC) and financial auditor information
requests - Review and responds to proposed audit adjustments; calculate financial impact on any open years
- Asses and identify cause of actual cost versus TEFRA cap variances; identify need for and prepare TEFRA exception requests as necessary
- Ensures completeness of interim cost reports and resulting true up G/L entries
- Analyze cost report results to ensure the most appropriate reimbursement considering Moffitt's cost based/PPS
- Complete monthly review of Medicare and Medicaid contractual allowances and third-party settlements
- Ensures all settlement and contractual allowance models accurately reflect all payment changes, cost report
impacts, and all other necessary data elements - Ensures all balance sheet settlement and contractual allowance accounts are reconciled and accurately reflect all transactions and current estimates
- Review monthly contractual allowances and settlement financial impacts; analyze and explain changes in actual
versus forecast and prior periods - Ensure completeness and accuracy of annual external audit workpapers
- Ensures all settlement and contractual allowance models accurately reflect all payment changes, cost report
- Serves as the Cancer Center's resource on Medicare and Medicaid reimbursement matters and regulations
- Monitor all proposed rules, laws and regulations impacting reimbursement for the the hospital and physician
practice; prepare analysis of financial impacts - Assist in financial modeling of new services, new locations and different reimbursement scenarios
- Ensure completion of necessary regulatory updates including enrollment updates, CMS 855A and other PECOS updates
- Develop quarterly forecast estimates for Medicaid Program Revenue and Medicare regulatory changes
- Collaborates with Managed Care and the Billing Office on regulatory matters
- Collaborates with external organizations (i.e., Alliance of Dedicated Cancer Centers, consultants, attorneys)
- Monitor all proposed rules, laws and regulations impacting reimbursement for the the hospital and physician
- Assess impacts of the State's Medicaid Programs
- Directly works with governmental relations and legal council to monitor impacts to the various Medicaid programs and ensure the optimal Medicaid program funding is received
- Estimates and records Medicaid program revenue (non-claim based) monthly
- Estimates and tracks available Intergovernmental Transfers (IGT's) to ensure adequate and optimal Medicaid
program funding
- Oversee and Supervise staff
- Complete annual performance evaluations and ongoing mentoring
- Ensure productivity and review work assignments
Credentials and Experience:
- Bachelor's Degree required - field of study: Finance, Accounting, or related field
- Minimum on ten (10) years' experience in Healthcare financial related field, including four (4) years in hospital reimbursement and experience with cost reporting.
- Preferred experience includes:
- Experience with patient billing and general ledger software.
- Experience with Medicare auditors and defending proposed adjustments.
- Experience with financial data.
- Preferred experience includes: