Reporting to the Senior Director Operations Reimbursement, the Director â�� Regional Reimbursement supports a market(s) which includes assisting the hospitals in the market(s) on reimbursement matters, pro-formas, and serving as the in-house industry expert on Medicare and Medicaid regulatory and reimbursement issues for the assigned hospitals/market(s).
Review monthly contractual models for Medicare and Medicaid for compliance and accuracy, inclusive of a review of open A/R for Medicare and Medicaid for reasonableness of estimated contractual allowance.
Provide and maintain applicable Medicare and Medicaid contractual models and related reimbursement factors/calculators to assist the hospitals with their month-end analysis and reviews. Prepare a management report each month during monthend close to highlight Medicare/Medicaid operational/budget variances and send to the hospital CFO/Controller for their review/information.
Review the Medicare crossover bad debt adjustments and prepare the crossover log for the cost report filing.
Perform a high-level review of the Medicare and Medicaid cost reports prior to filing by comparing the draft cost report to the Medicare/Medicaid model for the same time period. If there are any significant variances, the variances should be researched and explained, and a description of the corrective action necessary must be provided (either to the models or the cost report).
Provide guidance and review of the Medicare and Medicaid budget process for the assigned hospitals, as well as provide updated forecast guidance throughout the year.
Maintain a working relationship with the Government Relations department and provide guidance/financial feedback to the GR team during the State legislative session.
Become involved in the State Hospital Associations and any reimbursement committees they have to help stay abreast of proposed/adopted Medicaid regulations as well as Medicaid supplemental payment programs in the State.
Maintain, monitor and provide estimates for Medicaid supplemental payments â�� both from a cash flow and net revenue perspective.
Assist in Medicaid DSH audits and other supplemental payment data gathering/reviews as necessary and required for the assigned hospitals.
Perform regulatory research as necessary using federal and state websites, industry/trade sources, as well as work with user groups including internal/external counsel/consultants to source the information.
KNOWLEDGE, PRACTICAL EXPERIENCE AND LICENSURE/REGISTRATION REQUIRED:
Bachelorâ��s Degree in Accounting or Finance.
10+ years of hospital or Corporate reimbursement experience
Knowledge of cost reporting applications and concepts and a general knowledge of cost report software (HFS preferred)
Knowledge of Medicare statutes, regulations, and administrative rules as well as their related legislative and regulatory processes
Knowledge of Medicare reimbursement components and their respective calculations/regulations (e.g., Medicare DSH, Medicare UC DSH, IME & GME reimbursement, bad debts, etc.)
Working knowledge of Microsoft Office (Excel, Word, Access).
Normal office environment.
Some travel may be required.
Tenet Healthcare complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Primary Location: Dallas, Texas
Facility: 979-Dallas, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.