Director - Government Reimbursement

Overview:

Experience the advantages of real career change

Join Piedmont to move your career in the right direction. Stay for the diverse teams you’ll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You’ll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future. 

Responsibilities:

Organizing, coordinating, and performing the reimbursement function for Piedmont Healthcare and system entities, including the preparation of entity Medicare/Medicaid/ Tricare cost reports, surveys, audits, appeals, budget and planning in an effort to assist management in operational and compliance decisions. This position reports to the Piedmont Healthcare Government Reimbursement Executive Director.

 

KEY RESPONSIBILITIES:

1. Prepares and files Piedmont Healthcare Medicare/Medicaid/Tricare Cost Reports by applicable federal and state deadlines.

2. Prepares and maintains all schedules and analysis supporting cost report preparation.

3. Coordinates Medicare and Medicaid audits and prepares all supporting work papers and documentation.

4. Analyzes Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure accurate reimbursement and compliance with regulations.

5. Works with senior management to research, analyze, and communicate reimbursement issues.

6. Prepares pro-formas with regard to third party reimbursement.

7. Monitors regulatory changes for compliance and also seeks ways to optimize reimbursement.

8. Assists Piedmont Healthcare and system entities with reimbursement percentages for use in calculating contractual reserves. Provides the Government Reimbursement Executive Director with research and ad hoc reporting, as directed.

9. Provides documentation for use in calculating monthly reserve requirements for Piedmont Healthcare and system entities.

10. Prepares and assists Piedmont Healthcare and system entities with Medicare, Medicaid, and state surveys.

11. Reviews and analyzes Medicare and Medicaid Remittance Advices to ensure proper payments.

12. Ensures all third- party pass thru payments and lump sum adjustments are received as communicated by the Medicare Administrative Contractor (MAC) and account.

13. Reviews cost report settlements for accuracy and compliance with regulations.

14. Review cost report settlements and assists with appeal filings, where applicable.

15. Coordinates cost report reopening reviews and prepares all supporting documentation.

16. Assists with graduate medical education reporting for Piedmont teaching facilities.

17. Assists with the completion and timely submission of the Interns and Residents Information System (IRIS) software program to Medicare.

18. Prepares the Allied Health reporting and reimbursement for cost report filing.

19. Prepares the Wage Index and Occupational Mix Survey filings and reviews.

Qualifications:

Education

• Bachelor’s Degree in Accounting or a related field Required
• Master’s degree in Accounting or a related field Preferred

Work Experience

• 7 years of government healthcare reimbursement and accounting experience Required
• Experience with CMS PRM regulation manuals, the CMS 2552 software system, and the CMS IACS/ EIDM system Required

Licenses and Certifications

• None Required
• Certified Public Accountant (CPA) Preferred

Business Unit : Company Name: Piedmont Healthcare Corporate