Assistant Director, 3rd Party Reimbursement

Overview:

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community.

USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.

Responsibilities:

Holds 24-hour accountability for the operation of the department; coordinates all aspects of interim and annual Medicare and Medicaid, BCBS, and Champus Cost Reports and related activities, including work-paper preparation, document preparation, filings, audits appeals, adjustments and re-openings for all hospitals and the home office; responsible for the accrued balances for current and prior year cost reports; works with external contacts: CMS personnel and the fiscal intermediary personnel; works with external auditors regarding all Reimbursement Audits (Desk Reviews, S-10, Wage Index, FTE, CHGME); maintains competency in changes to reimbursement filing and reporting requirements for CMS, BCBS, Champus, CHGME and other payers to include maintaining awareness of changes and developments of new and proposed health core lows and regulations; serves as resource to deportment managers and Senior Management on reimbursement-related matters; updates and coordinates the training for departmental staff and others as necessary; assists with the preparation and filing of HCFA 855 and other certification forms as required; assists the Reimbursement Director with the preparation and filing of HCFA 855 and other certification forms as required; coordinates and files timely the initial and reconciliation applications for CHGME Grant funding. Maintains competency in operating the HRSA Online Electronic Handbook system. Works with Campus Grants Administration and Development to acquire proper signatures and ensure timely submission; coordinates and files the CHGME Annual Performance Report, this entails maintaining training on the annual changes and directing other staff members to prepare data accordingly as well as coordinating the submission of information with the responsible parties of the University; responsible for the oversight and coordination of the contracts for the monthly resident billings and assures their reconcilement, assuring processing and payment; responsible for the Affiliation Cap Sharing Agreements, assuring timely processing, submission and calculations for the Cost Report; develops and continually reviews department processes to improve the functions through effective use of information systems and coordination of efforts with other staff, including patient accounting, the Health System and University Finance Departments; monitors all reimbursement activities as well as other hospital activities effecting reimbursement; notifies management of any nets, transactions, or circumstances which ore not fully in compliance with federal, state, or local laws or regulations; develops and maintains efficient processes to support recording of contractual adjustments, bad debts and charity allowances for individual accounts, in the aggregate, and as they affect the financial statements of the operating divisions; reviews, verifies and reconciles balance sheet reserves, and Medicare, Medicaid, Blue Cross and Commercial or other Governmental settlement accounts; coordinates the efforts of University personnel, third party representatives, and outside consultants to ensure that all required reports and other submissions ore completed on a timely basis; schedules and prioritizes activities of assigned subordinates; communicates as required with personnel from University, hospitals, College of Medicine, third parties, regulatory agencies, or others in connection with work assignments, information gathering and reporting; completes periodic net revenue forecasts, contractual adjustment, bad debt, budgets, and other recurring and non-recurring reimbursement analysis and special projects; develops and improves relationships with third party payer personnel, intermediaries, and governmental agency personnel concerning reimbursement activities; promotes a positive image amongst all customers (internal and external) by exercising sound and ethical business practices as related to employees, patients, external contacts vendors and the general public, ensuring that the quality of products and service is of the highest possible level appropriate to the situation; maintains expertise with the reimbursement software, evaluating its adequacy for reimbursement purposes to insure that it is adequate for producing accurate and timely reports which fully comply with all payer requirements, government regulations, and applicable laws; coordinates the updating of the software and maintaining training of departmental staff; utilizes all available resources to assure effective performance; completes special project and provides financial analysis regarding third party payers as needed; supervises staff to include assigning duties, checking work, approving time off, preparing performance evaluations, and handling disciplinary issues; assists accounting in developing departmental budget and monitors budgetary expense and revenues, identifies variances and adjusts spending accordingly; coordinates and reviews required DSH reporting schedules for Alabama Medicaid; strong understanding of GME/IME requirements and New Innovations. Works with the GME office to ensure proper reporting and documentation for IRIS; expertise in the Cerner system with regards to tracing patient data related to charges, payments, balances and statistics necessary for Reimbursement reporting requirements; works with Alabama Medicaid to enroll new physicians and practices for the Physician Teaching Enhancement; regular and prompt attendance; ability to work schedule as defined and overtime as required; performs related duties as required.

Qualifications:

Bachelor’s degree in accounting, finance, business administration, or directly related field from an accredited institution as approved and accepted by the University of South Alabama and eight years of progressively responsible accounting or financial analysis experience. Directly related professional experience may substitute on a year-for-year basis for the required education.

Permanent