Manager Enterprise Reimbursement - Net Revenue PB

Overview

This role ensures hospitals are compliant with state and federal regulatory reporting requirements related to reimbursement. The position requires extensive knowledge of third-party reimbursement regulations and is responsible for managing net revenue, budget development, reserve analysis, and identifying and implementing revenue enhancement opportunities.

Responsibilities

• Ensure hospitals comply with state and federal regulations related to reimbursement.
• Prepare and conduct analytical review of external Medicare Cost Reports, WV HCA filings, and other state or federal reimbursement filings for all hospitals.
• Review and analyze state and federal reimbursement regulations to ensure compliance and present the financial impact of regulatory changes.
• Communicate with external auditors, third-party payors, and WV HCA staff regarding financial matters.
• Coordinate development of the net revenue budget.
• Establish a process for ongoing monitoring of gross and net revenue, including analysis of reserves for contractuals, bad debt, and charity.
• Coordinate with patient financial services and accounting to process changes in third-party payment requirements and assess impacts on financial reporting and financial statements.
• Ensure financial terms of managed care contracts are thoroughly analyzed and accurately monitored.
• Ensure long-range financial planning includes accurate and up-to-date reimbursement assumptions.
• Coordinate projects related to revenue enhancement opportunities.
• Work with legal counsel and the fiscal intermediary to identify and resolve outstanding Medicare appeal issues.
• Develop and maintain an ongoing staff development program and an orientation program for reimbursement staff.
• Monitor and document staff performance and use appropriate reward and disciplinary measures as needed.
• Demonstrate the ability to create an environment that motivates staff to work efficiently and regularly establish and achieve departmental goals.
• Provide leadership and direction to professional staff; maintain professional relationships, respond to staff concerns in a professional and timely manner, and maintain appropriate interdepartmental communication.

Minimum Qualifications

• Bachelor’s Degree in Business with a major in Accounting or Finance.
• Five (5) years of experience in healthcare finance or accounting.

Preferred Qualifications

• MBA or CPA.

Skills and Abilities

• Effective verbal and written communication skills and strong interpersonal skills.
• Extensive knowledge of personal computers; Excel software is desirable.

Scheduled Weekly Hours

• 40

Exempt/Non-Exempt

• Exempt

Location

• United States of America

Physical Requirements

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.

Work Environment

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job.

Cost Center

• 540 SYSTEM Finance and Reimbursement