The Sr. Reimbursement Process Coordinator is responsible for quality control and implementing the reimbursement functions at the Regional hospitals in order to complete Government required filings, determine the impact of federal regulations on hospital operations and maintain proper account analysis. This position is also responsible for review of third party accounts throughout the System all Region; preparation of monthly third party settlement entries for multiple assigned regions; and proper filing, audit and settlement of cost reports for multiple assigned facilities. The position serves as the champion and educator of uniformed software (EZ Workpapers) for all Regions and has the responsibility to train and maintain this software knowledge.
* Coordinate and review processes throughout the System specific to Medicare cost report software implementation, usage and maintenance for HFS cost report software and EZ WPs workpaper preparation software.
* Responsible for teaching all Regions new reimbursement software to standardize a uniform Reimbursement processes during site visits, webinars and annual reimbursement meeting updates.
* Prepare and review cost reports, completing comparative analysis of the cost report versus the financial statement and compliance checklist prior to submission, for assigned facilities. Timely completion of work is required to ensure Medicare, Medicaid and CHAMPUS cost reports are submitted by due dates to prevent loss of reimbursement to the facilities. Identify and pursue proper reimbursement methodologies in an effort to receive all reimbursement due based upon Medicare, Medicaid and CHAMPUS Regulations. Responsible for mid-year and annual reviews of third party payable/receivables and providing documentation and analysis as needed to external auditors.
* Prepare monthly calculations and journal entries to properly maintain contractual allowance and related settlement accounts, for assigned facilities. Maintain current, correct account analysis related to program Income Statement and Balance Sheet accounts. Ensure monthly reports are prepared timely and accurately by supporting departmental Associates.
* Coordinate with all regional, the Medicare field audits, provide complete, proper and timely information, and review audit adjustments prior to issuance of the Notice of Program Reimbursement, for assigned facilities. Errors found must be communicated in writing to the Auditors during the audit, to ensure proper settlement. Prepare audit adjustment analysis to determine reimbursement impact of adjustments to as filed cost report.
* Review prior year cost reports for any items requiring reopenings or appeals. Prepare or assist hospitals in preparation of reopenings, providing support throughout the process.
* Monitor interim payment rates to ensure proper interim rates are maintained
* Assist in research of and implementation of regulatory changes at the hospitals
* Assist manager with monthly management discussion analysis and narrative
* Identify and pursue opportunities for maximization of reimbursement and review all reimbursement due based upon Medicare and Medicaid regulations
* Serves as contact to assist outside consultants and/or Regional Leadership in preparation of reopening and appeal requests and subsequent position papers to appeal inappropriate settlements with the Provider Relations Reimbursement Board system wide.