Job Description

Employment Status:
Full time
Job Function:
Management and Executive
Department:
405001 Finance-Mgmt
Shift Hours / Days:
Hours / Pay Period:

Manager, Third Party (Government) Reimbursement

We Fight Cancer: Care That Never Quits®

Cancer Treatment Centers of America ® (CTCA®) delivers an extraordinary patient experience that delivers state-of-the-art, high quality care through an integrative model where a team of experts puts patients at the center of their own care. Every day is purposeful. Every day, you will help patients win the fight against cancer. Every day is challenging and rewarding beyond your imagination.

The Best Place to Work

We call ourselves Stakeholders because we all have a stake in the care and success of every patient. Today, CTCA Stakeholders deliver healing and hope to patients fighting complex and advanced cancer in Atlanta, GA, Chicago, IL, Philadelphia, PA, Phoenix, AZ and Tulsa, OK. Each of our hospitals earned a Best Place to Work distinction and has received numerous accreditations that celebrate our culture of clinical quality, innovation, high performance and wellness.

A Culture of Teamwork, Empowerment & Development

CTCA provides Stakeholders with exceptional support and easy access to a wide range of tools and resources they need to bring the best of themselves, every day. Our benefits, wellness, and compensation programs lead the market. Imagine accessing your own personal health coach! We also provide extensive training and career development opportunities that encourage professional and personal growth,it is a point of pride. Those are just a few of the ways we empower our Stakeholders to deliver the highest standard of care that we call the Mother Standard®.

 

The Manager, Third Party (Government) Reimbursement is responsible for overseeing reimbursement from government payer programs and ensuring compliance with reporting requirements.  These activities include the timely and accurate filing of all cost reports, wage index, and ongoing provider enrollment maintenance correspondence. The Manager is responsible for internal communication with the central billing office, accounting, and managed hospitals’ finance teams regarding changes in rates, interim payments, bad debt logs, resident time sheets, and accuracy of third party reserves. The Manager will also be expected to provide proactive guidance to management to understand the impact of proposed or finalized changes to the government payer programs such as MACRA, EHR incentives, etc.

The Manager, Third Party (Government) Reimbursement will supervise at least one Stakeholder and be responsible for his/her development, work assignment and performance evaluation.  As more analysts are needed, they will also report to the Manager.  All feedback will be given to the Corporate CFO who is the ultimate authority in personnel action. 

  • Ensure the timely and accurate submission of all required cost reports.  That currently includes cost reports with Medicare and Medicaid, as well as Champus capital/DME reimbursement requests for five short-term acute care hospitals.  In addition, there is also a home office cost report for Medicare.  Maintain proper analytical procedures to ensure oversight on trends that could adversely affect reimbursement such as changes in cost to charge ratios, increases in disallowed cost, and quality of supporting documentation for physician education and bad debt logs.  Keep adequate internal records in order to support the cost report audits.
  • Provide support for program auditors and represent CTCA in all cost report or reimbursement related audit/appeal activity.  Ensure that cost report settlement payables are reserved in advance and submitted on time, or that settlement receivables are processed accordingly.  When appropriate, the Manager also leads any cost report reopenings or appeal cases.
  • Perform periodic review of government program reimbursement to identify potential under or overpayments and communicate the results internally and externally to maintain compliance with program regulations.  Keep the rates and weights current in CTCA’s billing system and ensure that the accounting function’s monthly reserves for government AR are accurate.
  • Receive, interpret, and communicate to the appropriate managers any new program regulations, guidelines or requirements pertaining to reimbursement.  In addition, review reimbursement department policies from time to time—as well as the policies of any other department that affect Medicare reimbursement—for Program compliance and business effectiveness.

Requirements:

  • BS/BA in Business, Finance, Accounting, or related field. 
  • Must have minimum of 3-5 years healthcare finance experience with demonstrated knowledge of cost reporting and government payer oversight.
  • Must have a strong background in financial analysis and cost accounting. 
  • Thorough understanding of Microsoft Excel required.
  • Experience with cost reporting software is highly desirable. 
  • Familiarity with Medicare language, terminology, and program guidelines.
 
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