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Munson Healthcare Reimbursement Specialist in Traverse City, Michigan

ENTRY REQUIREMENTS

Bachelors Degree in Accounting or Finance, with CPA or Masters Degree in Business Administration preferred.

Experience in preparation of third-party financial and statistical reimbursement reports.

Five or more years experience in health care finance and third party reimbursement.

Experience with computer applications, including spreadsheet and cost report software.

Must be able to communicate and interact effectively and professionally with all customers and suppliers, internal and external. Must possess strong oral and written communication skills. Must maintain confidentiality of information and records. Must possess strong analytical and interpretative skills.

ORGANIZATION

This position is under the direction/supervision of the Reimbursement Manager.

This position will have contact and interaction with customers and suppliers in other departments and facilities. Some travel is required.

AGE OF PATIENTS SERVED

Cares for patients in the age category(s) checked below:

X No direct clinical contact with patients

SPECIFIC DUTIES

  • Supports the mission statement of Munson Medical Center (MMC): Munson Medical Center is the core of a regional health system. In partnership with physicians, we provide quality, compassionate, comprehensive and cost-effective services for improvement of the health of our patients and the communities we serve.

  • Embraces and supports the Continuous Quality Improvement (CQI) philosophy of Munson Medical Center: We are committed to the name "Munson" meaning excellence. We will provide services that meet our customers' requirements every time.

  • Adheres to Exceptional Skills with People (ESP) House Rules at all times.

  • Acknowledges that safety is a self-responsibility. Knows the physical requirements of the job and work within those guidelines. Performs job duties safely at all times, utilizing learned body mechanics and transferring/lifting techniques. Plans actions to promote safety. Reports any unsafe situation/equipment according to Hospital procedure.

  • Prepares and submits all financial and statistical reports required by all third-party governmental agencies for hospital reimbursements.

  • Analyzes financial and statistical data used in the reimbursement reports to determine accuracy, consistency from year to year, and effects upon institution’s reimbursement or final settlements.

  • Verifies and analyzes rate calculations submitted by third-party payers and governmental agencies for accuracy.

  • Verifies and analyzes final cost settlements submitted by third-party payors and governmental agencies for accuracy.

  • Coordinates third-party cost report audits and provides assistance in response to inquiries made by third-party auditors.

  • Reconciles revenue between hospital financial reports and third-party payor/governmental agency reports.

  • Prepares interim cost reports for independent audit review, the annual budget internal contractual estimation, and the case mix system.

  • Supplies reimbursement data to the case-mix reporting system. Reviews and analyzes reports created by the case mix system.

  • Provides up-to-date reimbursement rate information to the Accounting Department to enhance the monthly contractual allowance calculation. Periodically reviews the monthly contractual allowance calculation.

  • Participates in and suggests areas where formal appeals to third-party and governmental agencies are warranted. Prepares formal appeal work papers.

  • Assists in the preparation of special reimbursement and cost study analyses and in the accumulation of certain statistical data.

  • Performs other duties and responsibilities as assigned.

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