Manager, Government Reimbursement – Finance Operations – Full Time 8 Hour Days (Exempt) (Non-Union) – (Los Angeles, California, United States)

The Manager of Reimbursement at Keck Medicine of USC will manage governmental reporting and reimbursement, focusing on tasks such as completing and ensuring compliance with the Medicare Cost Report (MCR) and related Medicaid Cost Reports. Additionally, it involves managing cost report audits, appeals, reopening, and Provider Enrollment and Provider-Based Applications. The position also handles uncompensated care reporting, settlement account estimates, third-party audits, and various other reports supporting institutional financials.

Essential Duties:

  • Manage all Medicare, Medi-Cal and Tri-Care cost report filings and amendments on behalf of Keck Medicine of USC, home office and its hospitals.
  • Provides cost reimbursement and regulatory reporting summaries to reimbursement leadership.
  • Provides direction for government reimbursement programs.
  • Participates in the review of cost report preparation processes.
  • Recommends and participates in implementation of process improvements. Monitors and measures process changes.
  • Researches industry best practices and recommends process improvements to leadership.
  • Reviews and recommends policies that support any changes to government reimbursement rules, laws, and regulations.
  • Track and record all audits, data requests, auditor sampling and responses and appeals.
  • Prepares recommendations for improvements as a result of the audits to other operating areas for disposition.
  • Reviews all audit adjustments for accuracy and updates internal reporting processes accordingly. Identifies potential items for formal Medicare appeal.
  • Complete PIP quarterly reports.
  • Prepare MCR related journal entries and balance sheet reconciliations.
  • Responsible for settlement account monthly estimates and related analysis and third-party audits, as well as ad-hoc reports in support of institutional monthly financials.
  • Responds to intermediary inquires and other requests for information.
  • Responsible for overall human resource management to include staff education, development and mentorship, and quality improvement efforts for the Department.
  • Build a team of reimbursement analysts to support reimbursement leadership on projects and initiatives with strategic importance to the organization.
  • Responsible for strategic planning, fiscal management, and asset management for the Department
  • Prepares and manages annual operational budgets in the reimbursement cost center.
  • Keeps up to date on proposed and final IPPS and OPPS rules, CMS Bulletins, litigations, etc. and summarizes for reimbursement leaders.
  • Coordinates any PECOS or PAVE updates related to CMS Form 855-A.
  • Oversees the preparation and submission of Medicare Provider Based Applications in response to updates to services performed, locations or newly opened or closed hospital-based practices.
  • Provide uncompensated care reporting including the annual Community Benefit report and select items from Form 990 Schedule H.
  • Prepare worksheet S10 which includes Charity Care and Bad Debt listings.
  • Interfaces with third party vendors for outsourced work papers, such as Medicare bad debt, DSH reporting, etc.
  • Perform other duties as assigned.

Required Qualifications:

  • Req Bachelor’s degree in business, accounting or related field
  • Req 5 years Healthcare finance experience with demonstrated knowledge of cost reporting and government payer oversight OR
  • Req 5 years Accounting/reimbursement/finance experience
  • Req Experience working in specialty areas such as subacute units, certified transplant center, a PPS-exempt dedicated cancer hospital delivering BMT and CAR-T therapies.
  • Req Experience in PPS and non-PPS reimbursement and a working knowledge of regulatory and compliance requirements therein.
  • Req Experience in GAAP and healthcare financial accounting/reporting consolidation processes.
  • Req Deep understanding of healthcare government reimbursement, accounting, and business processes, including finance, quantitative analysis, financial analysis, healthcare economics, information systems, and process improvement.
  • Req Demonstrate the ability to collect, analyze, and synthesize complex financial data and information systems.
  • Req Demonstrate skills in project planning, reviewing, and ensuring work is organized and documented.”
  • Req Sound business judgment and creative problem-solving attributes.
  • Req Working knowledge of Hospital Revenue Cycle (Patient accounting, collections, denials, etc.) and related reporting.
  • Req Proficiency with Microsoft Office (i.e., Excel, Word, PowerPoint).
  • Req Demonstrate experience and knowledge of Medicare reimbursement guidelines.

Preferred Qualifications:

  • Pref Master’s degree in accounting or finance
  • Pref 3 years progressive management experience in professional healthcare, finance, accounting or related field.

Required Licenses/Certifications:

  • Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The annual base salary range for this position is $110,240.00 – $181,896.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

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