JOB SUMMARY

Oversees production of monthly contractual model analysis, cost report preparation, varied reimbursement analyses, and other Revenue Integrity functions including managed care contracting, denials management and Charge Description Maintenance (CDM).

The Manager, Revenue Integrity and Reimbursement is the first and primary individual within Memorial Healthcare responsible for regulatory compliance with reimbursement related matters. Individual proactively monitors regulatory and reimbursement changes, analyzing impact on Memorial Healthcare, and recommending strategic and operational responses to such changes.

Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

JOB RELATIONSHIPS

Responsible To: Associate Vice President of Finance

Workers Supervised: Revenue Integrity Specialist, Revenue Integrity Analyst,

Senior Reimbursement Analyst, Business Intelligence Analyst - Revenue Cycle

Inter-Relationships: Works with leadership team; internal and external customers

PRIMARY JOB RESPONSIBILITIES

Monitors and assists in preparation of work papers for third-party cost reports and utilizes outside consultants as appropriate and assists in various phases of third-party cost report audit.

Participates in various phases of annual independent audit by CPA firm as well as mid-year review of third-party contractual allowances.

Responsible for the people, systems and processes for revenue integrity, charge control functions, and the performance of revenue integrity metrics.

Implements revenue enhancement initiatives and education.

Keeps abreast of current payer medical policies and makes any changes to prevent loss in reimbursement.

Responsible for Charge Description Maintenance and enhancement by analyzing departmental charges, identifying and implementing charge improvements, assisting individual departments with reconciling charge discrepancies, and determining the reimbursement impact of CPT revisions.

Responsible for preparation of monthly financial reimbursement model for monthly accounting close. Interacts with CFO, AVP/Finance and Finance Director.

Responsible for all healthcare reimbursement matters for Memorial Healthcare.

Responsible for Third party audits, including Medicare, Medicaid and Blue Cross.

Proactively monitors regulatory and reimbursement changes, analyzes impact on Memorial Healthcare, and recommends strategic and operational changes in response.

Monitors, evaluates and calculates impact of state supplemental Medicaid Payments – QAAP, MACI, HRA, etc.

Monitors DSH percentage for assurance of continued 340b eligibility.

With assistance from MMA Quality Manager will quantify incentive payments received from third party payers and other sources.

Works with Patient Financial Services and clinical departments in matters related to reimbursement and the regulatory environment.

Assists with Managed Care contracting, negotiations and analysis.

Develop and maintain scorecards related to Managed care contracts.

Responsible for completing financial forecasts and assisting with annual revenue budget and rate setting.

Responsible for the annual budget for third-party contractual allowances.

Skilled at managing multiple projects to assist clinical and administrative leadership related to reimbursement.

Manage reimbursement information requests to evaluate goals and uses of the information to provide complete and accurate analysis to leadership. Including cost analysis of potential new service lines and explanation of conditions that could impact reimbursement.

Conducts disciplinary discussion and completes required documentation in a respectful, timely manner.

Completes staff performance evaluations within appropriate timeframes.

Completed annual department budget and maintains departmental expenses within budget or provides reason for approved variance.

Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.

Other duties as assigned

JOB SPECIFICATIONS

EDUCATION

Masters’ Degree in Accounting/Finance highly preferred. Bachelor’s Degree in Accounting/Finance required.

EXPERIENCE

5 or more years’ experience in healthcare finance in a reimbursement environment with cost report and audit preparation and preparation of month-end contractual allowance highly preferred.

Experience with managed care contracting highly preferred.

3-6 years’ in an accounting or finance related position required.

ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS

Able to travel independently throughout all Memorial Healthcare facilities.

Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC).

ESSENTIAL TECHNICAL ABILITIES

Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.

ESSENTIAL MENTAL ABILITIES

Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.

Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.

ESSENTIAL SENSORY REQUIREMENTS

Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.

Able to see and hear for work-related purposes.

INTERPERSONAL SKILLS

Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.

Required to remain calm when adversity is encountered.

Open, honest, and tactful communication skills.

Ability to work as a team member in all activities.

Positive, cooperative and motivated attitude.