Responsible for organizing, coordinating, and performing the reimbursement function for Piedmont Healthcare and system entities, including the preparation of entity Medicare/Medicaid/ Tricare cost reports, surveys, audits, appeals, budget and planning in an effort to assist management in operational and compliance decisions.
KEY RESPONSIBILITIES:
1. Prepares and files Medicare/Medicaid/Tricare Cost Reports by applicable federal and state deadlines.
2. Prepares and maintains all schedules and analysis supporting cost report preparation.
3. Coordinates Medicare and Medicaid audits and prepares all supporting work papers and
documentation.
4. Assists with preparation and filing of Piedmont Healthcare and system entities cost reports.
5. Analyzes Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure
accurate reimbursement and compliance with regulations.
6. Works with senior management to research, analyze, and communicate reimbursement issues.
7. Prepares pro-formas with regard to third party reimbursement.
8. Monitors regulatory changes and updates; seeks ways to optimize reimbursement.
9. Assists Piedmont Healthcare and system entities with reimbursement percentages for use in calculating
contractual reserves. Provides Finance with research and ad hoc reporting.
10. Provides documentation for use in calculating monthly reserve requirements for Piedmont Healthcare
and system entities.
11. Prepares and assists Piedmont Healthcare and system entities with Medicare, Medicaid, and state
surveys.
12. Reviews and analyzes Medicare and Medicaid Remittance Advices to ensure proper payments.
13. Assists in budgeting contractuals for Piedmont Healthcare and system entities.
14. Ensures all third party pass thru payments and lump sum adjustments are received as communicated
by the Medicare Administrative Contractor (MAC).
15. Reviews cost report settlements for accuracy and compliance with regulations.
16. Review cost report settlements and assists with appeal filings, where applicable.
17. Coordinates cost report reopening reviews and prepares all supporting documentation.
18. Assists with graduate medical education reporting for Piedmont teaching facilities.
19. Assists with the completion and timely submission of the Interns and Residents Information System
(IRIS) software program to Medicare.
20. Assists with the completion of the annual Medicare bad debt logs.
21. Assists with the Allied Health reporting and reimbursement for cost report filing.
22. Assists with the preparation of the Wage Index and Occupational Mix Survey filings and reviews.
