Sys Manager Reimbursement-Government Programs Appeals

Where You’ll Work

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Job Summary and Responsibilities

JOB SUMMARY / PURPOSEProvides leadership, management, and coordination related to the government reimbursement services of Dignity Health. Ensures timely and accurate financial and governmental reporting by managing the reimbursement programaccording to relevant policy terms and conditions. Identifies and implements strategies, policies, procedures and programs for all aspects of reimbursement management practices. Monitors and communicates federal and stateregulatory proposals and changes regarding healthcare reimbursement and provides effective solutions to address reimbursement service needs. Oversees, evaluates and improves the productivity and performance of staff members.

• Reimbursement Management: Manages the organization's reimbursement activities, ensuring timely and accurate financial reporting, and implements related strategies, policies, and procedures.
• Regulatory & Policy Expertise: Monitors and communicates federal and state regulatory changes in healthcare reimbursement, providing effective solutions to address associated issues.
• Team Leadership: Manages the productivity and performance of reimbursement staff members.
• Reporting & Audits: Possesses knowledge of Medicare/Medicaid cost reporting, actively reviews and assists with hospital cost reporting, and prepares for third-party audits.
• Financial Analysis & Accounting: Applies financial analysis tools and accounting methods to read, interpret, and maintain accurate financial statements and reports, including monthly net revenue reviews.
• State & Regulatory Compliance: Understands state supplemental programs (including projections and bookings), works with State Hospital Associations, and ensures compliance with federal, state, and local healthcare regulations.

Job Requirements

MINIMUM QUALIFICATIONS

Required Education and Experience

Bachelor's Degree in Accounting, Finance, Business Administration or related field.

Minimum of five (5) years of intensive experience with Medicare and Medicaid reimbursement,

two (2) years of net revenue experience and minimum of two (2) years of management experience. Experience filing cost reports with TransplantPrograms and working with Transplant Coordinators.