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Manages the daily operations of the reimbursement staff while establishing systems and processes related to the calculation of third-party reimbursements for University of New Mexico Hospital and Sandoval Regional Medical Center entities which entails highly complex analysis and risk mitigation. Ensure adherence to Hospitals and departmental policies and procedures. No patient care assignment.
SUPERVISION - Hire, Train, Mentor, and Educate new reimbursement analysts to ensure consistent, accurate and timely reporting regarding audits, provider enrollment, cost reporting, reimbursement strategies, and departmental processes
REGULATIONS - Keep abreast of Federal and State regulations that impact reimbursement for the Medicare, Medicaid, IHS, and TriCare programs
COMPLIANCE - Adhere to all department and hospital policies and procedures, generally accepted accounting principles, and Federal and State regulations regarding Medicare and Medicaid reporting
REIMBURSEMENT - Investigate potential opportunities for increased reimbursement
TRAINING - Ensures adequate cross-training between analysts occurs to mitigate a gap in knowledge due to turnover
WORKSHEETS - Preparation of Worksheet S-10 of Cost Report(s) to include coordination with Patient Financial Services Department and Decision Support Staff to ensure accuracy and completeness of DSS Charity Care and Bad Debt Reports utilized in preparation of Worksheet S-10
AUDITS - Interact with Fiscal Intermediaries for Program Audits; communicate with department director regarding material adjustments
SUPERVISION - Supervise day-to-day duties of department Sr. Reimbursement Analyst(s); Monitor and evaluate reimbursement analysts to ensure a high level of staff productivity to include annual evaluations
COST REPORTS - Review at a detail level the Medicare, Medicaid, IHS, and TriCare Cost Reports and DSH Audit Surveys prior to the final review by the Department Director; ensure all Federal and State filing deadlines are met
Bachelor's Degree in related discipline
3 years directly related experience
Experience must be directly related to hospital cost reporting and auditing either in a hospital provider setting or at a Medicare/Medicaid fiscal intermediary
Physical Demands Requirements:
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Working Conditions Requirements:
May be required to perform subordinate tasks in high census/vol
No or min hazard, physical risk, office environment