This position is responsible for maximizing the Medicare/Medicaid/Champus reimbursement for all entities with multiple reimbursement variations and/or specialty areas (ex. Medical Education, Transplant Program, Bond Interest Reporting, etc.) reported through the annual cost reports and the Part B Carrier billing for professional fees. Serves as a resource for personnel for all Medicare/Medicaid/Champus reimbursement issues.
Calculates, reviews, and analyzes the monthly contractual allowance for Medicare, Medicaid , and/or Champus. Prepares a quarterly analysis of the accounts receivable reserve to ensure the provisions are adequate. Prepares the Medicare/Medicaid/Champus cost reports using data from multiple sources. Ensures the maximum third-party reimbursement is reported through the cost reports and to the Carrier for professional fees.
Provides information to the third-party auditors to support the data reported and ensures maximum reimbursement. Reviews proposed audit adjustments to ensure accuracy. Coordinates appeals and exception requests. Provides information to the financial auditors for reimbursement related accounts including current year and prior year reserves.
Calculates the reimbursement impacts for the organizational changes, regulatory changes in reimbursement, and/or payment changes by the intermediaries and carriers.
Acts as a resource for management, facility controllers, department directors, committees, teams, etc. related to all Medicare/Medicaid/Champus reimbursement issues. Maximizes reimbursement by working with various personnel. Provides Medicare/Medicaid/Champus reimbursement education/training to the Reimbursement Services staff and other financial/facility staff.
Obtains knowledge of source documents (General Ledger, Income and Expense Summary, Stat and Revenue Report, Patient Account System, Cost Accounting System, Accounts Payable System, etc.) to determine the most accurate information to be reported.
Requires a Bachelor degree in business, accounting or related field or equivalent experience.
Requires advanced knowledge of Medicaid/Champus reimbursement. Knowledge of Medicare reimbursement regulations to include different inpatient reimbursement methods, and specialty areas and maintain highly confidential data. Must be able to work with minimal supervision and prioritize multiple projects. Requires excellent human relations skills and the ability to effectively interact and communicate both verbally and in writing with all levels staff and outside professionals.
Proven advanced, analytical, and modeling skills are necessary. Must be proficient in the use of sophisticated software programs.
Additional related education and/or experience preferred.
Internal Number: 260283
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.