Director of Government Reimbursement

JOB PURPOSE: 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 thru 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. Reviews 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. KNOWLEDGE, SKILLS, ABILITIES: Proficient in graduate medical education regulations and reporting requirements. Skill and ability for effective verbal and written communications. Skill and ability to handle multiple projects, priorities, and deadlines. Proficient in Microsoft Office applications and CMS2552 Cost Report Software. Must be able to work as a member of a team. In-depth knowledge of the healthcare reform and how the healthcare industry is changing. Must be able to interpret, implement, and communicate the impact of Medicare, Medicaid, and TriCare regulations. MINIMUM EDUCATION REQUIRED: Bachelors degree in Accounting or a related field. MINIMUM EXPERIENCE REQUIRED: Seven (7) years of government healthcare reimbursement and accounting experience. Must have knowledge and experience with CMS PRM regulation manuals, the CMS 2552 software system and the CMS IACS/EIDM system. ADDITIONAL QUALIFICATIONS: MBA and/or CPA preferred. Previous MAC/Fiscal Intermediary/Federal CMS experience preferred.

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