Job Description

Job Summary

Utilize reimbursement experience to manage the Medicare/Medicaid reimbursement functions for his/her assigned hospitals and provide guidance to BMHCC for his/her assigned system responsibilities. Under the direct supervision of the System Director of Reimbursement, incumbent is responsible for one shift, eight hours/day, five days/week and is subject to overtime and call-back as required by BMHCC.

Job Responsibilities

• Responsible for overseeing the preparation of Medicare/Medicaid cost reports for his/her assigned hospitals utilizing the resources of departmental staff and consultants. The incumbent reviews all cost reports prior to filing to ensure accuracy and compliance with all applicable Medicare/Medicaid rules and regulations.
• Responsible for responding to Medicare/Medicaid audit requests and developing documentation to challenge audit findings as necessary.
• Responsible for developing appeal and reopening requests of previously settled Medicare/Medicaid cost reports for his/her assigned hospitals. This will involve working closely with hospital staff, outside consultants and attorneys as necessary. Incumbent will develop all necessary documentation to support these requests and will strictly adhere to the filing deadlines set by Medicare/Medicaid.
• Responsible for serving as a system resource for various issues that affect all hospitals as assigned by the System Director of Reimbursement. Incumbent will communicate new updates and critical information to internal and external customers and provide training as needed. Incumbent must remain up-to-date in all facets of the Medicare/Medicaid rules and regulations.

Minimum Qualifications

Education: Minimum of a Bachelor’s Degree in Accounting or equivalent as appropriate.

Experience: 5+ years experience as a Medicare auditor or as a Reimbursement Specialist/Manager in a multi-hospital environment. In addition, previous experience as a hospital controller would be desirable.

Licensure, Registration, Certification: CPA, MBA or professional certification would be desirable.