Director - Government Reimbursement

Piedmont; Atlanta (GA); On-site; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare organization in Atlanta seeks an experienced reimbursement specialist to manage government healthcare reimbursements, preparing cost reports and complying with audits. The ideal candidate will possess at least 7 years of relevant experience with healthcare accounting standards and systems. A Bachelor's degree in Accounting is mandatory, while a Master's degree and CPA certification are preferred. Join us to help improve patient outcomes through effective financial management.

Qualifications

• 7 years of government healthcare reimbursement and accounting experience required.
• Experience with CMS PRM regulation manuals, the CMS 2552 software system, and the CMS IACS/EIDM system required.
• Certified Public Accountant (CPA) preferred.

Responsibilities

• Organize and perform the reimbursement function for Piedmont Healthcare including cost reports and audits.
• Prepare and file Medicare/Medicaid/Tricare Cost Reports.
• Coordinate Medicare and Medicaid audits and prepare supporting documentation.
• Analyze Medicare Administrative Contractor correspondence for compliance.
• Prepare pro-formas regarding third party reimbursement.

Education

Bachelor's Degree in Accounting or a related field

Master's degree in Accounting or a related field

Tools

CMS PRM regulation manuals

CMS 2552 software system

CMS IACS/EIDM system

Job description

Overview

Experience the advantages of real career change

Join Piedmont to move your career in the right direction. Stay for the diverse teams you’ll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You’ll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.

Responsibilities

Organizing, coordinating, and performing the reimbursement function for Piedmont Healthcare and system entities, including the preparation of entity Medicare/Medicaid/Tricare cost reports, surveys, audits, appeals, budget and planning in an effort to assist management in operational and compliance decisions. This position reports to the Piedmont Healthcare Government Reimbursement Executive Director.

Key Responsibilities

• Prepares and files Piedmont Healthcare Medicare/Medicaid/Tricare Cost Reports by applicable federal and state deadlines.
• Prepares and maintains all schedules and analysis supporting cost report preparation.
• Coordinates Medicare and Medicaid audits and prepares all supporting work papers and documentation.
• Analyzes Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure accurate reimbursement and compliance with regulations.
• Works with senior management to research, analyze, and communicate reimbursement issues.
• Prepares pro-formas with regard to third party reimbursement.
• Monitors regulatory changes for compliance and also seeks ways to optimize reimbursement.
• Assists Piedmont Healthcare and system entities with reimbursement percentages for use in calculating contractual reserves. Provides the Government Reimbursement Executive Director with research and ad hoc reporting, as directed.
• Provides documentation for use in calculating monthly reserve requirements for Piedmont Healthcare and system entities.
• Prepares and assists Piedmont Healthcare and system entities with Medicare, Medicaid, and state surveys.
• Reviews and analyzes Medicare and Medicaid Remittance Advices to ensure proper payments.
• Ensures all third‑party pass‑through payments and lump sum adjustments are received as communicated by the Medicare Administrative Contractor (MAC) and account.
• Reviews cost report settlements for accuracy and compliance with regulations.
• Review cost report settlements and assists with appeal filings, where applicable.
• Coordinates cost report reopening reviews and prepares all supporting documentation.
• Assists with graduate medical education reporting for Piedmont teaching facilities.
• Assists with the completion and timely submission of the Interns and Residents Information System (IRIS) software program to Medicare.
• Prepares the Allied Health reporting and reimbursement for cost report filing.
• Prepares the Wage Index and Occupational Mix Survey filings and reviews.

Qualifications

Education

• Bachelors Degree in Accounting or a related field Required
• Masters degree in Accounting or a related field Preferred

Work Experience

• 7 years of government healthcare reimbursement and accounting experience Required
• Experience with CMS PRM regulation manuals, the CMS 2552 software system, and the CMS IACS/ EIDM system Required

Licenses and Certifications

• None Required
• Certified Public Accountant (CPA) Preferred

Business Unit : Company Name

Piedmont Healthcare Corporate