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Job Requirements of Senior Program Manager - Reimbursement:
-
Employment Type:
Contractor
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Location:
King of Prussia, PA (Onsite)
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Senior Program Manager - Reimbursement
Careers Integrated Resources Inc
King of Prussia, PA (Onsite)
Contractor
Title: Senior Program Manager - Reimbursement
Location: King of Prussia, Pennsylvania
Shift: Days (8:00 AM – 4:30 PM, 8 hours)
Role Overview
Location: King of Prussia, Pennsylvania
Shift: Days (8:00 AM – 4:30 PM, 8 hours)
Role Overview
- The Senior Program Manager - Reimbursement - Acute will manage Medicare and Medicaid fee-for-service reimbursement functions across multiple hospitals with complex reimbursement environments.
- This role ensures compliance with federal and state reimbursement regulations while optimizing reimbursement through strategic planning and financial analysis.
- Manage Medicare and Medicaid cost report submissions, including desk reviews, audits, and wage index reviews for multiple complex facilities.
- Provide independent consulting on hospital reimbursement matters including compliance, billing, and financial analysis to corporate offices, regional finance teams, and hospital executives.
- Lead reimbursement coordination for Medicare alternate payment methodologies, focusing on bundled payments for acute care hospitals.
- Oversee Medicare quality-based payment programs such as Value-Based Purchasing, Hospital Acquired Conditions, and Excess Readmissions.
- Review and ensure accuracy and compliance of Medicare and Medicaid contractual models and related reimbursement data.
- Participate in oversight and development of Medicaid supplemental payment programs (e.g., UPL, state Medicaid DSH) for assigned facilities.
- Bachelor’s degree with 10+ years of Medicare cost reporting experience.
- In-depth knowledge of Medicare prospective payment systems including Inpatient Acute DRGs, Outpatient APCs, Rehabilitation CMGs, and Psychiatric DRGs.
- Thorough understanding of Medicare statutes, regulations, and legislative processes, including Graduate Medical Education (GME) and Indirect Medical Education (IME) reimbursement.
- Strong grasp of Medicaid supplemental payment concepts, state directed payments, and provider tax assessments.
- Expertise in Medicare alternate payment concepts with emphasis on Bundled Payments.
- Familiarity with Medicare quality-based reimbursement concepts like Value-Based Purchasing and Hospital Acquired Conditions.
- Intermediate to advanced proficiency in Microsoft Excel.
- Experience with McKesson G/L and Client Invision systems.
- Proficiency in HFS cost report software or equivalent.
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