[Hiring] Government Reimbursement & Cost, Manager @Emory Healthcare

Role Description

The Manager of Government Reimbursements reports to the Director of Reimbursements and Net Patient Service Revenue (NPSR) and is responsible for overseeing the financial analysis, reporting, and compliance related to federal and state governmental reimbursements for Emory Healthcare. This role leads financial reporting and analysis associated with Medicare, Medicaid, and other governmental reimbursement programs, including cost reporting, audit coordination, and regulatory compliance. The manager ensures accurate and timely revenue recognition and reimbursement estimation while partnering with hospital operations, clinical departments, and finance teams to support financial reporting and regulatory reporting requirements.

Responsibilities

• Government Reimbursement Reporting & Compliance
  • Prepare and oversee Medicare and Medicaid cost reports and monitor compliance with CMS regulations and required attestations.
  • Report and monitor all supplemental Federal and State reimbursement programs.
  • Coordinate Medicare and Medicaid audits and prepare supporting documentation and work papers across Emory Healthcare.
  • Assist with provider-based attestations and associated Federal and State reporting requirements.
  • Monitor and interpret correspondence from Medicare Administrative Contractors (MAC) regarding interim rate setting and reimbursement compliance.
• Financial Analysis & Reporting
  • Conduct detailed financial analyses to evaluate revenue performance, reimbursement trends, and operational impact.
  • Analyze payer mix and operational changes affecting governmental reimbursements.
  • Develop financial insights and recommendations to improve reimbursement performance.
  • Prepare and review statistical reports, financial statements, and supporting schedules for leadership.
  • Develop long-range financial and cash flow forecasting models.
• Regulatory Monitoring & Policy Compliance
  • Monitor Federal and State regulatory changes impacting hospital and physician reimbursement requirements.
  • Assist with monitoring billing and reimbursement changes affecting hospital and physician chargemasters.
  • Develop recommendations on policy changes to ensure ongoing regulatory compliance.
  • Support development and implementation of internal control procedures related to governmental reimbursements.
• Cost Reporting & State Reporting
  • Prepare and assist with annual State of Georgia Department of Community Health (DCH) reporting requirements including:
    • Disproportionate Share Hospital (DSH)
    • Graduate Medical Education (GME)
    • Hospital Financial Survey (HFS)
    • Indigent Care Trust Fund Survey (ICTF)
  • Manage graduate medical education reporting and support initiatives to maximize reimbursement opportunities.
  • Assist with preparation and review of hospital Upper Payment Limit (UPL) and physician Low Income Pool (LIP) reporting.
• Strategic Financial Planning
  • Conduct strategic pricing analysis associated with annual charge master pricing and net revenue planning.
  • Evaluate new business initiatives and assess governmental reimbursement impacts.
  • Develop pro-forma financial analyses related to third-party reimbursement models.
• Audit & Financial Controls
  • Develop year-end audit documentation and oversee preparation of supporting financial schedules.
  • Partner with internal and external auditors to interpret financial schedules and resolve discrepancies.
  • Develop and implement control procedures to strengthen internal financial reporting processes.
• Data Management & Reporting Efficiency
  • Develop and implement methods to improve reporting accuracy and efficiency.
  • Identify and develop reporting tools required by Federal and State regulatory agencies.
  • Partner with vendors to support reimbursement analysis and reporting initiatives.
• Leadership & Team Development
  • Provide guidance and direction to professional staff.
  • Supervise workflow, policies, and procedures related to governmental reimbursement reporting.
  • Manage special projects and financial impact studies.
  • Support staff development and continuing education initiatives.
• Professional Development
  • Participate in professional activities and industry organizations to maintain knowledge of reimbursement regulations and healthcare finance trends.
  • Attend continuing education programs and professional development opportunities.
• Additional Duties
  • Perform additional responsibilities as assigned.

Qualifications

• Bachelor’s degree in Accounting, Finance, Data Analytics, Business Analytics, Information Systems, or a related field.
• Minimum of six (6) years of related experience required.
• Experience preparing Medicare and Medicaid cost reports required.
• Strong knowledge of Medicare and Medicaid reimbursement regulations.
• Excellent analytical and problem-solving skills.
• Strong leadership and team management abilities.
• Ability to interpret complex reimbursement regulations and financial data.

Preferred Qualifications

• MBA or CPA preferred.
• Experience within complex academic healthcare systems and transplant programs preferred.
• Experience with the following systems preferred:
  • Epic
  • StrataJazz
  • PeopleSoft
  • SQL
  • Power BI
  • EPSI
  • Kodiak (RCA)

Physical Requirements

(Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks.

Environmental Factors

Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste; Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at [email protected]. Please note that one week's advance notice is preferred.