Reimbursement Manager

Lehigh Valley Health Network, Inc.; United States; À distance; USD 90 000 - 130 000; Plein temps

Résumé du poste

Lehigh Valley Health Network, Inc. seeks an experienced professional to interpret Medicare and Medicaid payment regulations and lead cost reporting activities for the organization.

The role focuses on ensuring accurate cost reports, optimizing reimbursement across all programs, and providing expert guidance on compliance and opportunities for improvement. Strong independent work and collaborative skills are essential in a remote setup.

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.

Responsabilités

• Calculates the financial impacts of purchasing, readmissions, hospital acquired infections, and accountable care arrangements.
• Develops strategies and processes to ensure compliance with Medicare/Medicaid regulations.
• Develops processes to complete cost reports and ensure reimbursement for all programs and services.
• Provides expert guidance on Medicare and Medicaid reimbursement and payment regulations.
• Identifies opportunities to maximize reimbursement for all hospital programs and services.
• Supports participation in cost report appeals and related group appeals.
• Evaluates firms for cost report appeals and selects appropriate consultants.
• Supports revenue budgeting related to cost report-driven reimbursements.
• Reviews third-party settlements monthly and aligns with close schedules.

Connaissances

Medicare/Medicaid regulation

Cost reporting experience

Independent work

Formation

Bachelor's Degree

Description du poste

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. and
• 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.

https://youtu.be/GD67a9hIXUY

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