Major Responsibilities:
- Plans and prepares revenue analysis for system wide programs, projects and services, and monitors revenue budgets and benchmarking activities. Identifies and researches opportunities to enhance revenue and improve administrative efficiency of governmental payor programs. Works with the Manager of Reimbursement in conjunction with financial and operational leadership to implement the opportunities identified.
- Reviews government agency bulletins, publications, and the Federal Register to understand proposed and actual state and federal government statutory and regulatory changes that impact Aurora and analyzes the financial and operational impact of the changes to Aurora. Works with the Manager of Reimbursement to develop a plan to communicate the impact of the statutory and regulatory changes to finance and operational leadership. Coordinates Aurora’s response to government agencies on proposed rulemaking and assists with making necessary operational changes to maximize Aurora’s reimbursement under these government programs.
- Serves as one of the Aurora representatives on the state Medicaid Hospital Rate Advisory Group, Health Care Quality Coalition, and Wisconsin Hospital Association Medicaid Advisory Group. Participates regularly in national, statewide and regional public forums designed to inform payers and providers on policy changes to government payor programs. Working with the Manager of Reimbursement, advocates for administrative flexibility within government regulations in order to improve efficiency and obtain proper coverage for services.
- Provides support as needed to Finance and Operations on reimbursement related matters. Assists with the preparation of the model template to be utilized in the annual budget process for third party reimbursement.
- Prepares and/or provides necessary information required for the completion of the annual Medicare and Medicaid interim and year-end cost reports. Supports/coordinates all system Fiscal Intermediary data requests, audits and exit conferences. Develops and maintains appropriate relationships with the Fiscal Intermediary.
- Prepares analysis and provides recommendations to ensure that all regulatory reviews are completed accurately and on time.
- Develops and provides coordination for the system-wide monthly closing process with respect to Medicare/Medicaid liabilities.
- Monitors processes to ensure accurate payment for Medicare/Medicaid and monitors interim payments to determine accuracy, appropriateness and potential liability. Requests adjustments from United Government Services (UGS) and updates internal systems.
- Works with Graduate Medical Education programs to ensure proper Medicare and Medicaid reimbursement and minimize governmental audit exposure through compliance with regulations specific to medical education programs. Assists with the development of pro forma analysis for new potential community partnerships (i.e., FQHC partnerships, dental residency, etc.) to project future budgets, as well as identify state and federal reimbursement to support these new care delivery models.
Licensure, Registration, and/or Certification Required:
Education Required:
- Bachelor's Degree in Finance or related field.
Experience Required:
- Typically requires 5 years of experience in reimbursement that includes experiences in preparation of Medicare/Medicaid cost reports, regulations and the analysis, modeling and reporting of third party payers.
Knowledge, Skills & Abilities Required:
- Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting.
- Knowledge and understanding of third party regulations and the interrelationship of financial statements to not only comply with regulations but to maximize and develop strategies to increase the organization's reimbursement rate with ongoing changes.
- Demonstrates strong initiative and produces high quality analytical results. Able to perform tasks independently.
- Strong accounting background with experience in preparing and/or reviewing health care financial statements which are required to perform accurate account analysis.
- Strong proficiency in the use of the Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools or similar products.
- Proficiency in data mining and analysis.
- Demonstrated ability to work and function in a complex environment. Excellent written and verbal communication skills and the ability to communicate revenue cycle issues to all levels of the organization.
- Demonstrated ability to take initiative, produce high quality results, and perform assigned activities in an independent manner. Self-motivated and capable of carrying a project through to successful completion.
Physical Requirements and Working Conditions:
- Must be able to sit the majority of the workday.
- Must be able to lift up to 10 lbs. occasionally.
- Operates all equipment necessary to perform the job.
- Exposed to normal office environment.
- This position requires travel, so will be exposed to weather and road conditions.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
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