Government Reimbursement & Cost, Manager - Emory Healthcare

Be inspired.  Be rewarded. Belong. At Emory Healthcare. 

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.  We provide: 

• Comprehensive health benefits that start day 1 

• Student Loan Repayment Assistance & Reimbursement Programs 

• Family-focused benefits  

• Wellness incentives 

• Ongoing mentorship, development, and leadership programs  

• And more 

Work Location: REMOTE 

RESPONSIBILITIES:

• This position reports to the Director, Reimbursements and Net Patient Service Revenue (NPSR), and oversees analysis and reporting for Governmental Reimbursements for Emory Healthcare.
• The Manager of Government Reimbursements is responsible for overseeing the financial reporting and analysis related to governmental reimbursements both federal and state, including cost reporting and audits.
• This role involves ensuring accurate and timely revenue recognition and calculating the estimated reimbursements for Emory Healthcare.
• The manager will work closely with hospital operations, clinical departments, and the finance team to support the financial reporting associated with the governmental reimbursements and required cost reporting compliance.
•  Responsible for preparing cost reports, monitoring compliance with CMS regulations, attestations, and preparing to report on all supplemental Federal and State reimbursement matters
•  Coordinates Medicare and Medicaid audits and assists with preparation of all supporting work papers and documentation across Emory Healthcare
•  Conducts detailed financial analyses to monitor revenue performance, identify trends, and develop insights to improve governmental reimbursements
•  Analyzes Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure accurate reimbursement and compliance with regulations
•  Assists with monitoring changes in Federal and State regulations regarding hospital and physician reimbursement requirements, with priority focus on billing changes impacting physician and hospital chargemasters
•  Assist with Provider based attestations, and all Federal and State reporting associated with them
• Monitors changes in Federal and State regulations affecting the healthcare industry and assists with preparation of pro-forma analysis as it relates to third-party reimbursement
•  Reviews and assists with preparation of the annual State of Georgia, DCH Reports, including DSH, GME, Hospital Financial Survey (HFS) and Indigent Care Trust Fund Survey (ICTF), etc.
•  Manages graduate medical education reporting and helps to provide organizational guidance to maximize reimbursements
•  Assists with preparation and review of annual hospital UPL and physician LIP reporting and other regulatory/contractually obligated reports
•  Prepares research, analyzes, and communicates reimbursement matters
•  Reviews and assists with strategic pricing analysis in association with the annual budget for charge master pricing and net revenues.
•  Develops year-end audit documentation; reviews and oversees detailed schedules and analysis to support financial statements. Works with external and internal auditors to interpret schedules and resolve discrepancies
•  Develops control procedures and assists in the development of new procedures to improve internal control measures
•  Prepares, develops, and monitors the budget and compliance with fiscal constraints related to governmental reimbursements for actual, budget and prior period financial information
•  Develops and reviews information and analysis for long-range financial and cash flow forecasting
•  Reviews and analyzes data trends in governmental reimbursements, works with vendors to develop analysis and support on-going and future reimbursements
•  Enhances and improves analysis to determine the impact of payer mix and changes to operations on governmental reimbursements
•  Develops recommendations to management
•  Identifies and reviews analysis involving new business initiatives and models governmental reimbursement impacts
•  Creates recommendations on policy issues to maintain compliance with regulations and guidelines
•  Enhances and is proactive in implementing procedures consistent with established policies
• Supervises and analyzes current policies and procedures and assesses effectiveness
•  Oversees and manages special projects
•  Oversees the preparation of special impact studies and other financial surveys and questionnaires
• Ensures professional development and attends educational in-services as appropriate.
•  Participates in professional activities and organizations to maintain knowledge of current trends, practices, and developments
•  Reviews, prepares and analyzes statistical reports, financial statements, and supporting schedules for management
•  Identifies, develops, and implements methods for improving reporting efficiency. Identifies requirements and develops reports required by state and federal agencies and ensures compliance.
•  Provides guidance and direction to professional staff
•  Performs related responsibilities as required

MINIMUM QUALIFICATIONS:

• 6 years related experience required with an MBA or CPA preferred.
• Experience in preparation of Medicare and Medicaid cost reports required.
• Experience with complex academic healthcare and transplants preferred.
• Strong knowledge of Medicare and Medicaid reimbursement regulations.
• Excellent analytical and problem-solving skills.
• Proven leadership and team management abilities.
• Preferred technical qualifications: Knowledge and experience with Epic, Stratajazz, PeopleSoft, SQL, Power BI, EPSI and Kodiak (RCA).

EDUCATION:

• A bachelor's degree in accounting, finance, data or business analytics or information systems related field Remote available for the right candidate Additional Details Supporting a diverse, equitable and inclusive culture.
• Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status.
• EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law.
• EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals.
• EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.
• Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.

Supporting a diverse, equitable and inclusive culture.  Emory Healthcare (EHC) is dedicated to providing equal opportunities and access to all individuals regardless of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression and/or veteran's status. EHC does not discriminate on the basis of any factor stated above or prohibited under applicable law. EHC respects, values, and celebrates the unique perspectives and backgrounds of all individuals. EHC aspires to create an environment of collaboration and true belonging for all our patients and team members.  Emory Healthcare (EHC) is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. 

ACCOMMODATIONS: EHC will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion.”  

PHYSICAL REQUIREMENTS: (Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks. 
 
ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.