Sys Manager Reimbursement-Government Programs Appeals

Where You’ll Work

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Job Summary and Responsibilities

JOB SUMMARY / PURPOSEProvides leadership, management, and coordination related to the government reimbursement services of Dignity Health. Ensures timely and accurate financial and governmental reporting by managing the reimbursement programaccording to relevant policy terms and conditions. Identifies and implements strategies, policies, procedures and programs for all aspects of reimbursement management practices. Monitors and communicates federal and stateregulatory proposals and changes regarding healthcare reimbursement and provides effective solutions to address reimbursement service needs. Oversees, evaluates and improves the productivity and performance of staff members.

ESSENTIAL KEY JOB RESPONSIBILITIESManages the healthcare organization's reimbursement activities and initiatives, to ensure timely and accurate financial reporting.Identifies and implements strategies, policies, procedures and programs for all aspects of reimbursement management practices.Monitors and communicates federal and state regulatory proposals and changes regarding healthcare reimbursement and providing effective solutions to address reimbursement issues.Manages the productivity and performance of reimbursement staff members.Cost Reporting – Knowledge of Medicare/Medicaid cost reporting process, timelines and regulations. Review and assist with hospital cost reporting in assigned Market & Region, transplant program and teaching program experience.Financial Analysis - Knowledge of tools and approaches of financial analysis; ability to read, interpret and draw accurate conclusions from financial and numerical material.Third Party Audits - Knowledge of healthcare industry audit processes conducted by external organizations or agencies; ability to prepare for the entire audit process.

Financial Reporting - Knowledge of processes, methods, and tools of financial reporting; ability to create and maintain accurate and thorough financial reports.Accounting - Knowledge of accounting methods, processes, and tools; ability to use these to maintain and prepare financial statements and reports.Net Revenue – assist and review monthly net revenue checklist & assist with account reviews to communicate with CFO’s.State Supplemental Programs – Knowledge of state supplemental programs and assist with projections and monthly bookings. Work with State Hospital Associations to understand program changes and report to division and systemleaders.Healthcare Regulatory Environment - Knowledge of federal, state and local healthcare related laws and regulations; ability to comply with these in healthcare practices and activities.

Job Requirements

MINIMUM QUALIFICATIONS

Required Education and Experience

Bachelor's Degree in Accounting, Finance, Business Administration or related field.

Minimum of five (5) years of intensive experience with Medicare and Medicaid reimbursement,

two (2) years of net revenue experience and minimum of two (2) years of management experience. Experience filing cost reports with TransplantPrograms and working with Transplant Coordinators.