MGR REIMBURSEMENT

At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America’s Best Large Employers and America’s Best Employers for Women, Computerworld magazine’s list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time’s Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet® designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999.
Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision.

Summary

Position Highlights:

• The Manager of Reimbursement is responsible for the Cancer Center’s Medicare and Medicaid reimbursement matters.
• This includes the annual and interim third party cost report completion and monthly contractual allowances and settlement adjustments.
• The Manager is responsible for achieving accurate third-party reimbursement.  
• Moffitt is a cost-based PPS exempt Cancer Center with significant cost report settlement activities.
• This position serves as an expert resource for the Cancer Center in the areas of Medicare and Medicaid regulatory/settlement matters. 

The Ideal Candidate:

• The ideal candidate will have Healthcare financial experience, including hospital reimbursement and experience with cost reporting.
• The ideal candidate will have experience with patient billing and general ledger software and have experience with Medicare auditors and defending proposed adjustments

Responsibilities or Essential Functions:

• Prepares and files Medicare Cost Reports ensuring strict compliance with all Medicare regulations, policies, procedures and guidelines
  • Analyze cost report results to ensure the most appropriate reimbursement considering Moffitt's cost based/PPS
    exempt status.
  • Maintaining and reviewing for reasonableness all cost allocation statistics; recommend changes as necessary
  • Responds to third party auditors, Medicare Administrative Contractor (MAC) and financial auditor information
    requests
  • Review and responds to proposed audit adjustments; calculate financial impact on any open years
  • Asses and identify cause of actual cost versus TEFRA cap variances; identify need for and prepare TEFRA exception requests as necessary 
  • Ensures completeness of interim cost reports and resulting true up G/L entries
• Complete monthly review of Medicare and Medicaid contractual allowances and third-party settlements
  • Ensures all settlement and contractual allowance models accurately reflect all payment changes, cost report
    impacts, and all other necessary data elements
  • Ensures all balance sheet settlement and contractual allowance accounts are reconciled and accurately reflect all transactions and current estimates 
  • Review monthly contractual allowances and settlement financial impacts; analyze and explain changes in actual
    versus forecast and prior periods
  • Ensure completeness and accuracy of annual external audit workpapers 
• Serves as the Cancer Center's resource on Medicare and Medicaid reimbursement matters and regulations
  • Monitor all proposed rules, laws and regulations impacting reimbursement for the the hospital and physician
    practice; prepare analysis of financial impacts
  • Assist in financial modeling of new services, new locations and different reimbursement scenarios
  • Ensure completion of necessary regulatory updates including enrollment updates, CMS 855A and other PECOS updates 
  • Develop quarterly forecast estimates for Medicaid Program Revenue and Medicare regulatory changes 
  • Collaborates with Managed Care and the Billing Office on regulatory matters 
  • Collaborates with external organizations (i.e., Alliance of Dedicated Cancer Centers, consultants, attorneys)
• Assess impacts of the State's Medicaid Programs
  • Directly works with governmental relations and legal council to monitor impacts to the various Medicaid programs and ensure the optimal Medicaid program funding is received 
  • Estimates and records Medicaid program revenue (non-claim based) monthly 
  • Estimates and tracks available Intergovernmental Transfers (IGT's) to ensure adequate and optimal Medicaid
    program funding
• Oversee and Supervise staff
  • Complete annual performance evaluations and ongoing mentoring 
  • Ensure productivity and review work assignments

Credentials and Experience:

• Bachelor’s Degree required – field of study: Finance, Accounting, or related field
• Minimum on ten (10) years’ experience in Healthcare financial related field, including four (4) years in hospital reimbursement and experience with cost reporting.
  • Preferred experience includes:
    • Experience with patient billing and general ledger software.
    • Experience with Medicare auditors and defending proposed adjustments.
    • Experience with financial data.