Facility
Cape Fear Valley Medical Center
Location
Fayetteville, North Carolina
Department
Reimbursement
Job Family
Professional
Work Shift
Days (United States of America)
Summary
Assists with the development, administration and monitoring of reimbursement services, strategies and goals and ensures compliance with regulatory requirements.
MAJOR JOB FUNCTIONS:
The following is a summary of the major essential functions of this job. The position requires other duties, both major and minor, that are not mentioned below, and specific functions may change time to time.
- Assists in the health system's reimbursement function (to include CFVMC, SRRC, BHC, EMS, Outreach Clinics/Offices and any other related entities) for the Medicare, Medicaid, and Tricare programs.
- Assists in the preparation of the annual Medicare and Medicaid cost reports including the coordination of information required to prepare the report such as the program logs, financial and statistical data, and physician time studies.
- Assists with periodic rate changes as initiated by the fiscal intermediary, CMS and/or other regulatory agencies.
- As assigned, reviews current changes in governmental reimbursement regulations to ensure the organization is in compliance.
- Help develops new record keeping procedures as required by new reimbursement regulations or payment methods.
- Assists with any health system audits, reviews or certifications conducted by the fiscal intermediary.
- Address informational requests between the fiscal intermediary and the independent auditors, as assigned by the Manager
- Analyze, interpret and coordinate appropriate changes according to Healthcare government regulations, transmittals and intermediary bulletins for Medicare, Medicaid and Tricare, as assigned
- Assists with Reserve Analysis on assigned hospitals that measures the adequacy of Medicare/Medicaid Reserves.
- Assists senior staff in reviewing existing operating procedures and makes recommendations to maximize operating efficiency and reimbursement.
- Assists with Special Projects to include feasibility studies, financial analyses, contract negotiations, proformas, and financial/operational reviews for possible acquisitions.
- May be involved in calculating monthly third party contractual allowances and journal entries.
- Performs other job-related duties as directed.
Qualifications:
The following qualifications or equivalents are the minimum requirements to perform the essential functions of this job.
- Knowledge and/or training in the use of Cost Report software, preferably HFS.
- Experience with spreadsheets, including pivot tables, advanced filters and Sunif and Vlookup functions.
Education and formal training:
Associates degree in Accounting, Finance or other related field required.
Work Experience:
Minimum of three years experience in a hospital reimbursement environment, or Intermediary (MAC). . Candidate has a working knowledge of Medicare and Medicaid regulatory requirements for compliant hospital billing and financial reporting with multi-facility experience.
Knowledge, skills and abilities required:
Ability to perform diverse tasks with firm deadlines without sacrificing accuracy and quality. Requires an experienced Windows, Excel, and Word user. Must be computer literate. Requires the ability to grasp new concepts quickly. Must possess effective communication skills with the capability of communicating with various levels of management.
Physical Requirements:
Must be able to see and read reports, computer display terminals and have manual dexterity to keypunch data via a keyboard. Requires mobility to meet with management at their service area throughout the facility. May require extended periods of sedentary work and extended working hours to meet stated objectives.
Audit and Technical Competencies:
- Assists in maintaining policies and procedures for regulatory compliance
- Analyze, interpret and coordinate appropriate changes according to Healthcare government regulations, transmittals and intermediary bulletins for Medicare, Medicaid and Tricare.
- Receive, organize and maintain a central repository of all healthcare regulations and bulletins.
- Assist with creating and maintaining system procedures for ensuring appropriate government changes are processed timely and accurately system wide.
- Develop, recommend and update policies and procedures for areas of responsibility consistent with legal and regulatory requirements.
- Communicate with external consultants and the Medicare intermediary for final interpretations of regulatory guidelines, as needed.
Education and Reporting:
- Up to date knowledge of Federal guidelines
- Provides education, training, assistance and expertise in the implementation of changes and regulatory interpretations.
Required Licenses and Certifications
Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity