Overview

Description 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 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 Acquisition and Medicare Disproportionate Share/Uncompensated Care. The 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: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Prepare and review monthly third party settlement 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, and Tricare. Analyze monthly third party settlement 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 settlement models are prepared timely and accurately by supporting departmental Associates. Assist and review monthly third party settlement templates, Uncompensated Care template and reimbursement entries in Cash to Net spreadsheet for accuracy. Maintain proficiency in software tools (i.e.,Toyon Absolute Solution, HFS cost report software, HFS IRIS, STRATA, ) and assist in education of Reimbursement staff as needed. 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. Work with System associates to 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. Assist department leadership in analysis 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, Tra