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ClearSky hospitals provide high-quality care that transforms the lives of those living with disabling injuries and illnesses. We distinguish ourselves through our commitment to excellence, to our patients, to our employees, and to the communities we serve.
Minimum Education & Experience
Required Licenses, Certification, and/or Documentation
Required Knowledge, Skills, and Abilities
- Remote Position
ClearSky Health is looking for a Reimbursement Manager to join our team! This person will be responsible for Medicare and Medicaid reimbursement including calculation of third-party reimbursements, Medicare facility adjusted base rates, monitoring and evaluating changes in reimbursement, creating and submitting accurate cost reports, managing audits including desk reviews, and assisting with overall Accounts Receivable reserve accuracy including policies and processes.
Essential Function
- Calculates and communicates reimbursement rates for Medicare and Medicaid programs for all hospitals including new developments. Calculates and informs all parties on changes to facility adjusted base rates.
- Gathers data, creates and analyzes cost reports for timely submission and makes recommendations on changes in the business practice.
- Develops awareness and accountability on all aspects of Cost Reimbursements to ensure reimbursement revenue is accurately recorded, reported, and in compliance with CMS regulations.
- Reviews and analyzes potential effect of government Medicare and Medicaid regulations and changes on financial agreements/contracts.
- Monitors, evaluates Medicare, Medicaid, and other state reporting requirements to ensure compliance with regulations.
- Evaluates the impact of changes in accounting practices, and new/revised Medicare regulations on the cost reports and incorporates these changes to maximize reimbursement.
- Calculation of third party reimbursements and quarterly estimates, reconciles third party balance sheet account to reimbursement expectations, review other revenue reimbursement entries for accuracy.
- Manages audits, desk reviews and audit coordination for external/internal and regulatory financial audits, and remediation of audit findings for the reimbursement area/department.
- Completes and submits Medicare and Medicaid hospital provider applications, updates, assist with payer credentialing, and other filings as needed.
Minimum Job Requirements
Minimum Education & Experience
- Bachelor’s Degree in Accounting required.
- 3-5 years’ experience in Medicare and Medicaid hospital reimbursement preferred.
- Experience with developing and submitting hospital Medicare Cost Reports preferred.
- Experience with Medicare Provider Enrollment preferred.
Required Licenses, Certification, and/or Documentation
- Must maintain acceptable driving record, current driver’s license, and insurability.
Required Knowledge, Skills, and Abilities
- Knowledge of current Medicare and Medicaid hospital regulation and reimbursement practices.
- Knowledge of payer types in the healthcare industry.
- Demonstrates general computer skills including data entry, word processing, email, and records management.
- Ability to maintain quality and safety standards.
- Ability to maintain proper levels of confidentiality.
- Ability to work closely and professionally with others at all levels of the organization.
- Effective organizational and time management skills.
- Effective written and verbal communication skills.
Remote position
