Director, Medicare/Medicaid Reimbursement

Position Summary

Responsible for oversite of financial analysis, processes, accounting, and reporting for reimbursement activities for system hospitals.

• Maintain knowledge of current regulations and assure the company is in compliance with them.
• Provide executives education on IME, GME, Provider Based rules, rural status.
• Provide system with ongoing financial oversight in reimbursement.
• Review Medicare/Medicaid cost reports with emphasis on accurate reimbursement to hospital.
• Review staff completion of all time studies, rotation schedules, statistics and bad debt logs, throughout the fiscal year that are used to complete the annual cost reports.
• Identifies opportunities to optimize reimbursement including capturing 340B discounts, combining or separating provider numbers.
• Review monthly close for third party settlement accounts and make sure each hospital is accurately reserved.
• Review staff responses to Medicare/Medicaid Intermediary to settle various cost report audits each year.
• Review the Champus Capital and GME Cost report for each hospital.
• Review year end Medicare Settlement schedules to maintain proper third-party liability accounts.
• Review third party reimbursement packages for external audit each year.
• Maintains compliance with all Orlando Health policies and procedures.
• Monitor wage index areas for geographical reclassifications to enhance reimbursement to each hospital.
• Develop Reimbursement skills in staff.
• Review annual IPPS, OPPS rules to find reimbursement opportunities for the system.
• Provide executive summary of changes in reimbursement impact to system to senior leaders
• Review LIP, and DPP schedule prepared by staff, ensure accuracy to achieve maximum allowable reimbursement.
• Review provider-based attestations for OP centers created with expansion of the system.
• Participates with other functional leaders on strategic initiatives to incorporate regulatory reimbursement concerns.

Bachelor’s degree in Accounting, Finance or Business Administration.

CPA required.

Ten (10) plus years in a leadership role in a complex health system.