MGR REIMBURSEMENT at H. Lee Moffitt Cancer Center – Tampa, Florida

Position Highlights:

• The Manager of Reimbursement is responsible for the Cancer Center’s Medicare and Medicaid reimbursement matters.
• This includes the annual and interim third party cost report completion and monthly contractual allowances and settlement adjustments.
• The Manager is responsible for achieving accurate third-party reimbursement.
• Moffitt is a cost-based PPS exempt Cancer Center with significant cost report settlement activities.
• This position serves as an expert resource for the Cancer Center in the areas of Medicare and Medicaid regulatory/settlement matters.

The Ideal Candidate:

• The ideal candidate will have Healthcare financial experience, including hospital reimbursement and experience with cost reporting.
• The ideal candidate will have experience with patient billing and general ledger software and have experience with Medicare auditors and defending proposed adjustments

Responsibilities or Essential Functions:

• Prepares and files Medicare Cost Reports ensuring strict compliance with all Medicare regulations, policies, procedures and guidelines
  • Analyze cost report results to ensure the most appropriate reimbursement considering Moffitt's cost based/PPS
    exempt status.
  • Maintaining and reviewing for reasonableness all cost allocation statistics; recommend changes as necessary
  • Responds to third party auditors, Medicare Administrative Contractor (MAC) and financial auditor information
    requests
  • Review and responds to proposed audit adjustments; calculate financial impact on any open years
  • Asses and identify cause of actual cost versus TEFRA cap variances; identify need for and prepare TEFRA exception requests as necessary
  • Ensures completeness of interim cost reports and resulting true up G/L entries
• Complete monthly review of Medicare and Medicaid contractual allowances and third-party settlements
  • Ensures all settlement and contractual allowance models accurately reflect all payment changes, cost report
    impacts, and all other necessary data elements
  • Ensures all balance sheet settlement and contractual allowance accounts are reconciled and accurately reflect all transactions and current estimates
  • Review monthly contractual allowances and settlement financial impacts; analyze and explain changes in actual
    versus forecast and prior periods
  • Ensure completeness and accuracy of annual external audit workpapers
• Serves as the Cancer Center's resource on Medicare and Medicaid reimbursement matters and regulations
  • Monitor all proposed rules, laws and regulations impacting reimbursement for the the hospital and physician
    practice; prepare analysis of financial impacts
  • Assist in financial modeling of new services, new locations and different reimbursement scenarios
  • Ensure completion of necessary regulatory updates including enrollment updates, CMS 855A and other PECOS updates
  • Develop quarterly forecast estimates for Medicaid Program Revenue and Medicare regulatory changes
  • Collaborates with Managed Care and the Billing Office on regulatory matters
  • Collaborates with external organizations (i.e., Alliance of Dedicated Cancer Centers, consultants, attorneys)
• Assess impacts of the State's Medicaid Programs
  • Directly works with governmental relations and legal council to monitor impacts to the various Medicaid programs and ensure the optimal Medicaid program funding is received
  • Estimates and records Medicaid program revenue (non-claim based) monthly
  • Estimates and tracks available Intergovernmental Transfers (IGT's) to ensure adequate and optimal Medicaid
    program funding
• Oversee and Supervise staff
  • Complete annual performance evaluations and ongoing mentoring
  • Ensure productivity and review work assignments

Credentials and Experience:

• Bachelor’s Degree required – field of study: Finance, Accounting, or related field
• Minimum on ten (10) years’ experience in Healthcare financial related field, including four (4) years in hospital reimbursement and experience with cost reporting.
  • Preferred experience includes:
    • Experience with patient billing and general ledger software.
    • Experience with Medicare auditors and defending proposed adjustments.
    • Experience with financial data.