Reimbursement Manager

Req #76969

Position Highlights :

• 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
• 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
• 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)
• 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.
30+ days ago