Capital Health Job Descriptions

VERSION:

1

JOB TITLE:

Manager Regulatory Reimbursement/Cost Reporting

COST CENTER:

000000

JOB CODE:

13993

FLSA Exemption Status:

Exempt

Telecommuting Eligible:

SUMMARY (Basic Purpose of the Job)

Manages and oversees the cost reporting and regulatory reimbursement functions for all of Capital Health (CH). Establishes processes and maintains oversight of all Federal and State cost report filings and other required filings to ensure that CH is compliant with its reporting obligations. Executes strategies to maximize reimbursement from CMS and other payors. Maintains an efficient operation that provides timely and accurate reimbursement.   Maintains comprehensive workpapers, time studies, and associated documents to support cost report filings and future year audit requests.

MINIMUM REQUIREMENTS

Education:

Bachelor's degree in accounting, finance, engineering or related field required. Master’s degree in a related field preferred.

Experience:

Five or more years progressive experience in healthcare reimbursement required.

Knowledge and Skills:

Possesses excellent organizational skills and verbal and written communication skills. Ability to effectively manage multiple projects simultaneously and ability to respond quickly in a fast-paced environment.

Special Training:

Mastery of advanced Excel a must, including v-lookup, IF formulas, pivot tables, etc. Proficient in Microsoft Suite, including Excel, Word and PowerPoint.  Experience analyzing large data sets required.

Mental, Behavioral and Emotional Abilities:

Ability to multi-task using organizational skills to manage multiple ongoing projects.

Usual Work Day:

8 Hours  

Reporting Relationships

Does this position formally supervise employees? Yes

ESSENTIAL FUNCTIONS

• Oversees the preparation and reviews federal and state cost reports and other regulatory processes/filings.
• Works with the Budget and Reimbursement team in the preparation and filing of the annual Federal and State cost report submission prior to filing deadlines.
• Gathers, reconciles, analyzes, and reviews data to prepare statutory calculations.
• Prepares appropriate supporting documentation for various areas of the Federal and State cost report submission and other reimbursement surveys as required. Filings will include compiling and analyzing large data sets to ensure amounts are categorized appropriately.
• Participates in strategic modeling exercises to determine impact on cost report, third party reserves, and 340b eligibility status.  Communicates findings to senior leadership.
• Responsible for the oversight and coordination of all regulatory reimbursement audits.  Reviews results and adjustments for accuracy, questions auditors as appropriate, and responds to inquiries in a timely manner.
• Identifies/analyzes reimbursement trends and evaluates the impact of policy changes on reimbursement.
• Oversees third party reserve analysis throughout the year.  Proposes adjustments, updates to methodologies and assumptions related to reserves as necessary.
• Provides consultation, training, and education to hospital executives, directors, managers and physicians to assist with time study requirements to support Federal cost report filings.
• Participates in state reimbursement committee meetings and attends regulatory reimbursement conferences.
• Participates in and is responsible for the annual operating budget process as it relates to government and subsidy revenue calculations and residency programs.
• Utilizes budget software to create and manage budget plans and evaluate impact of changing assumptions on projected and budgeted models.
• Utilizes reporting software to prepare financial profitability statements as it relates to residency programs and associated funding.  Analyzes and communicates finding to key stakeholders.
• Performs advanced level of Excel including VLOOKUP formulas, IF formulas, and pivot tables.
• Understands operating budget principles and can assist in yearly budget functions, as needed.
• Performs all other duties as assigned with a willingness to adapt to changing departmental demands. Maintains exceptional attention to detail.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include:

Occasional physical demands include: Standing, Walking , Climbing (e.g., stairs or ladders) , Carry objects , Bending

Continuous physical demands include: Sitting , Keyboard use/repetitive motion

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Moderate Hearing

Anticipated Occupational Exposure Risks Include the following: N/A