Director - Government Reimbursement

Director - Government Reimbursement

Experience the advantages of real career change

Join Piedmont to move your career in the right direction. Stay for the diverse teams you’ll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You’ll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.

Responsibilities:

Organizing, coordinating, and performing the reimbursement function for Piedmont Healthcare and system entities, including the preparation of entity Medicare/Medicaid/Tricare cost reports, surveys, audits, appeals, budget and planning in an effort to assist management in operational and compliance decisions. This position reports to the Piedmont Healthcare Government Reimbursement Executive Director.

Key responsibilities include:

• Preparing and filing Piedmont Healthcare Medicare/Medicaid/Tricare Cost Reports by applicable federal and state deadlines.
• Preparing and maintaining all schedules and analysis supporting cost report preparation.
• Coordinating Medicare and Medicaid audits and preparing all supporting work papers and documentation.
• Analyzing Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure accurate reimbursement and compliance with regulations.
• Working with senior management to research, analyze, and communicate reimbursement issues.
• Preparing pro-formas with regard to third party reimbursement.
• Monitoring regulatory changes for compliance and also seeking ways to optimize reimbursement.
• Assisting Piedmont Healthcare and system entities with reimbursement percentages for use in calculating contractual reserves.
• Providing the Government Reimbursement Executive Director with research and ad hoc reporting, as directed.
• Providing documentation for use in calculating monthly reserve requirements for Piedmont Healthcare and system entities.
• Preparing and assisting Piedmont Healthcare and system entities with Medicare, Medicaid, and state surveys.
• Reviewing and analyzing Medicare and Medicaid Remittance Advices to ensure proper payments.
• Ensuring all third-party pass thru payments and lump sum adjustments are received as communicated by the Medicare Administrative Contractor (MAC) and account.
• Reviewing cost report settlements for accuracy and compliance with regulations.
• Reviewing cost report settlements and assisting with appeal filings, where applicable.
• Coordinating cost report reopening reviews and preparing all supporting documentation.
• Assisting with graduate medical education reporting for Piedmont teaching facilities.
• Assisting with the completion and timely submission of the Interns and Residents Information System (IRIS) software program to Medicare.
• Preparing the Allied Health reporting and reimbursement for cost report filing.
• Preparing the Wage Index and Occupational Mix Survey filings and reviews.

Qualifications:

Education

• Bachelor’s Degree in Accounting or a related field Required
• Master’s degree in Accounting or a related field Preferred

Work Experience

• 7 years of government healthcare reimbursement and accounting experience Required
• Experience with CMS PRM regulation manuals, the CMS 2552 software system, and the CMS IACS/ EIDM system Required

Licenses and Certifications

• None Required
• Certified Public Accountant (CPA) Preferred

Business Unit: Company Name:

Piedmont Healthcare Corporate