Reimbursement Manager

1004 Lehigh Valley Hospital; Pennsylvania; Hybrid; USD 75,000 - 110,000; Full time

Job summary

Lehigh Valley Health Network is seeking a knowledgeable finance professional to interpret Medicare and Medicaid payment regulation and guide hospital activities to optimize revenue and ensure compliance.

You'll develop and execute processes to gather information required for Medicare and Medicaid cost reports, and complete these reports accurately and by filing due dates. The role supports cost report preparation, reviews third party settlements, and contributes to revenue budgeting.

Qualifications

• Bachelor's degree in a relevant field.
• 5 years interpreting Medicare and Medicaid payment regulation and completing Medicare and Medicaid cost reports.
• Ability to work independently.

Responsibilities

• Calculates financial impacts of purchasing, readmissions, infections, and ACO arrangements.
• Develops strategies and processes to ensure hospital compliance with Medicare/Medicaid regulations.
• Develops processes to complete cost reports and ensure hospital receives payment for programs and services.
• Provides expert guidance on Medicare/Medicaid reimbursement and payment regulation.
• Supports participation in cost report appeals and related processes.
• Reviews third party settlements monthly and aligns with closing schedules.

Skills

Medicare/Medicaid knowledge

Independent worker

Education

Bachelor's Degree

Job description

Imagine a career at one of the nation's most advanced health networks. Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work. LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day. Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

Interprets Medicare and Medicaid regulation and direct hospital activities to comply with government payment regulation and optimize Medicare and Medicaid revenue. Develops and executes processes necessary to gather information required for completion of the Medicare and Medicaid cost reports and is responsible to complete the cost reports accurately and by the filing due dates.

Job Duties

• Calculates the financial impacts of purchasing, readmissions, hospital acquired infections, and accountable care arrangements.
• Develops strategies and implement processes to ensure the hospital is in compliance with Medicare and Medicaid regulation.
• Develops processes needed to complete cost reports and ensure the hospital is paid for all programs and services.
• Provides expert guidance on complying with Medicare and Medicaid reimbursement and payment regulation.
• Provides expert advice to identify opportunities to achieve reimbursement for all programs and services provided.
• Provides support for participation in cost report appeals and cost report group appeals.
• Evaluates firms organizing group appeals and recommend firms and consultants to use in preparing and follow appeals.
• Supports the revenue budget process for items where reimbursement is calculated on the cost report.
• Reviews third party settlements monthly and updates in accordance with the monthly and fiscal year end closing schedules.

Minimum Qualifications

• Bachelor’s Degree 5 years Interpreting Medicare and Medicaid payment regulation and completing Medicare and Medicaid cost reports.
• 5 years Recording revenue and determining cost settlement receivables/payables for Medicare and Medicaid payments
• Ability to work independently.

Physical Demands

• Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require. Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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Lehigh Valley Health Network does not accept unsolicited agency resumes. Agencies should not forward resumes to our job aliases, our employees or any other organization location. Lehigh Valley Health Network is not responsible for any agency fees related to unsolicited resumes.

Work Shift: Day Shift Address: 1200 S Cedar Crest Blvd Primary Location: REMOTE IN PENNSYLVANIA Position Type: Remote Union: Not Applicable Work Schedule: Monday-Friday 8:00A-4:30P Department: 1004-13115 CSS-Finance Lehigh Valley Health Network (LVHN) is the region’s largest employer and health care provider of choice. Our nearly 20,000 health care professionals take pride in what they do and are driven by our mission to heal, comfort and care for the people of our community.

LVHN is honored to be certified as a Great Place to Work®. LVHN’s culture of trust – and the positive things colleagues said about working at LVHN when surveyed by Great Place to Work and Fortune – align perfectly with what makes a great workplace. This designation tells you that LVHN is a great place to work from hire to retire. If you are someone who aligns with LVHN’s core values – Compassion, Integrity, Collaboration and Excellence – you will have a rewarding and successful career here.