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Job Description :Audit & Reimbursement III - Medicare Cost Report AuditLocations: This is a virtual position; the ideal candidate will live within 50 miles of an Elevance Health PulsePoint location.
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Perform complex Medicare cost report audits, serving as an in-charge auditor assisting other auditors assigned to the audit. Under guided supervision, the Audit and Reimbursement III will gain experience on complex issues involving the Medicare cost report and Medicare Part A reimbursement.
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Work with Finance and Billing to establish a system to approve all pre-transplant charges for inclusion on the Medicare cost report. Completes Medicare time studies in a timely manner for inclusion on the Medicare cost report.
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Major duties of an Appeals Coordinator include providing comprehensive and efficient analytical support to prepare Medicare cost report appeal filing and associated supporting documents, communicating with hospital clients, MACs, and Provider Reimbursement Review Board (PRRB) staff, preparing and editing correspondence of legal documents, calendar management, docket management, and maintaining files.
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A Medicare Appeals Coordinator at Hall Render Killian Heath & Lyman will perform a wide variety of tasks to support a busy litigation practice challenging Medicare cost report policies.
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The Medicare Cost Report & Reimbursement Manager will act as the day-to-day leader of Northside Hospital’s Government Reimbursement Function. This position will require leadership skills and will also require maintaining a high degree of knowledge on Medicare Cost Report instructions, data inputs, and changes to Medicare and Medicaid regulations related to Reimbursement.
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Assist in the preparation of the Medicare Cost Report and the HRSA UDS report. Knowledge of Medicaid and Medicare Cost Reporting. Knowledge of non-profit accounting and relevant federal, state and local government accounting.
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Working with consultants and/or third-party platforms, responsible for the preparation and completion of the Medicare Bad Debt and DSH Log which is an instrumental pass-thru reimbursement component of the Medicare cost report.
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Also included under the oversight of the CFO is Revenue Cycle Management, Patient Experience, Accounts Payable management, Budget & Forecasting, Payroll, Cash Management, General Ledger, Account Reconciliation, Population Health and Grants Management, Health Resource and Services Administration (HRSA) grant reporting as related to the Electronic Handbook (EHB) and Uniform Data Systems (UDS), Medicare and Medicaid Cost Report activities.
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Keep up to date with federal statutes surrounding participation in Medicare and Medicaid programs including but not limited to EMTALA, Medicare fraud and abuse issues, Star legislation, and IRS guidelines pertaining to the operation of not-for-profit entities.
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Properly identify and verify third‐party coverage, sliding fee scale eligibility and complete appropriate forms (i.e., insurance verification form, income information form, Availity, Medicare questionnaire[MSP], Medicaid verifications, etc.
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Able to demonstrate a broad knowledge of third party insurance, Managed Care, Medicare, Medi-Cal, Medicare Advantage, HMO, and PPO regulations governing home health and hospice. The MCL's overall responsibility is to negotiate service authorizations and fees with the payor sources’ designated case managers and to interpret/report the patient's needs and progress to that case manager.
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Maintains Medicare bad-debt cost report by tracking billings, monitoring collections, and compiling information. Specialty, Specialties, Medical Group, Center, Medicine, Practice Manager, Manager, Clinic Manager, Management, Clinic Leader Practice Management, Leadership, Executive, Executive Director, Healthcare Management, Health Administration, Administration, Office Manager, Medical Office, Non-Profit, Community, billing, revenue cycle, director, manager.
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Conducts research to update and maintain Local Coverage Determinations (LCD's) for DME, Orthotics, Supplies etc., and report findings to operation manager and director. Knowledge of HMO, PPO, POS, Medicare and other Commercial Insurance DME Regulations and guidelines.
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The Centers for Medicare and Medicaid Services (CMS) rated Stamford Hospital as a five-star hospital for Overall Quality and The Leapfrog Group awarded Stamford Hospital an "A" for patient safety.
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