Experienced Reimbursement Manager with a demonstrated history of working in the hospital & health care industry. Skilled in Analytical Skills, Medicaid, Medical Compliance, Healthcare, and Healthcare Management. Strong professional with a Master of Science focused in Accounting from Harding University.
Strong presentation skills
Independent judgment and decision making
Knowledge of Medicare and Medicaid statutes and regulations
Regional Manager of Reimbursement, 11/2015
to 02/2017 Company Name – City,
Supervised the preparation, filing, and subsequent audits of the Medicare and Medicaid Cost Report for the CHRISTUS Acute Care Hospitals.
Reviewed Medicare & Medicaid Receivable / Payable month end close templates.
Coordinated with external consultants the Medicare and Medicaid Disproportionate Share, Wage Index, and Medicare Bad Debt reviews; Cost Report reopenings, and ad hoc projects as needed.
Consistently complied with applicable laws and regulations and ensured facility adhered to Medicare and Medicaid regulations.
Reimbursement Manager, 02/2013
to 11/2015 Company Name – City,
Preparation of Medicare, Medicaid, and Commercial Net Revenue templates for month end close for long-term acute care hospitals.
LTACH Cost Report preparation and subsequent audits; oversight of Hospice and
Home Health Agencies Cost Report preparation.
Home Care cost reports preparation and audits (PHC is a division of Texas HHSC )
Director of Regulatory Reporting - Financial Services / Reimbursement Manager, 05/2004
to 02/2013 Company Name – City,
Duties and accomplishments include
filing, and subsequent audits of the Medicare and Medicaid Cost Report. The 2011 Medicaid cost report settlement
included over $180 million subject to audit and final settlement
executed in-house preparation of the new IRS Form 990s with a standardized work
paper package and new tax software for 6 entities. Key areas of the Form 990 include executive
compensation and the necessary tracking of Community benefit costs for Schedule
extensively with CFO and CAO to estimate impact to Children's Health of Texas'
Medicaid budget changes as well as the implementation of APR - DRGs
for Medicaid state reporting tools including Medicaid DSH, corresponding MCD
DSH audit, and Section 1115 Waiver UC
(Uncompensated Care) Tool
software to facilitate the filing of the Children's Graduate Medical Education program
application, audit, and Annual Report.
Medicare / Medicaid Provider enrollment filings including 855s, Provider Based
Attestations, and Texas Medicaid enrollments for APNs and Home Care with
internal and external reporting agencies
of the Medicaid Meaningful Use Electronic Health Records work group
the team responsible for regulatory reporting requirements
Leadership Academy graduate
Senior Reimbursement Analyst, 07/2002
to 05/2004 Company Name – City,
Prepared Medicare / Medicaid cost report for new Heart and Vascular Hospital.
Key components involved extensive related organization transactions and AR allowance analyses for month end close.
Assisted in the preparation of Baylor University Medical Center cost report.
Key components involved multiple transplant programs, settlement data, Medicare disproportionate share, and assisting with the Medicare audits.
Developed excel spreadsheets to assist in cost report preparation, month end close, and financial analysis review.
Received Five Star Spirit Award for identifying and making recommendations to correct problems in contractual allowances postings in Meditech.
Continued to work with the Heart and Vascular Hospital to ensure that Medicare and Medicaid A/R and Net Revenue were properly stated.
Medicare/Medicaid Reimbursement Manager, 01/2001to 07/2002 Company Name – City,
Reviewed Medicare / Medicaid cost reports for 14 facilities, including sole community, rural hospitals, and newly acquired Quorum acute care facilities.
Conducted on site reviews and provided assistance for new facilities with the Medicare / Medicaid portion of month end close.
On site reviews included reviewing the facilities' current month end close process and recommending changes to the current processes to ensure consistency between the Triad and newly acquired Quorum facilities.
Worked extensively with newly acquired facilities to transition them to the Triad Budget Analysis, Contractual Analysis, and Account Reconciliation Models.
to 01/2001 Company Name – City,
Client Budget & Finance.
Performed Due Diligence reviews on Home Health Agencies, Rural Hospitals, and Skilled Nursing Facilities.
Medicare / Medicaid Reimbursement Manager, 05/1997
to 07/2000 Company Name – City,
Medical City Dallas Hospital.
Prepared Medicare/Medicaid contractual allowances using HCA exhibit model, Patient Accounting, and G/L systems.
Supervised Medicare / Medicaid logging clerks.
Prepared Medicare cost report work papers.
Member of numerous Medicare Compliance Task Forces
Reimbursement Manager, 07/1991
to 05/1997 Company Name – City,
Prepared Medicare / Medicaid cost reports for 7 facilities.
Facilitated Medicare cost report audits and financial audits of Medicare/Medicaid Due To/From receivables / payables.
Reviewed and assisted Controllers as needed in preparation of month end Medicare / Medicaid contractual exhibits.
Reimbursement Specialist, Company Name – City,
Prepared Cost Report for Harris Fort Worth and Long Term Care Hospital.
Rehab, Skilled Nursing, Related Organizations, Provider Based Physicians, Organ Acquisition, Home Health Agency, Medicare DSH, IME/GME, and wage index were components of the cost reports.
Facilitated Medicare cost report audits.
Supervised Medicare logging clerks.
Assisted with Medicare / Medicaid month end contractual exhibits.
Senior Field Auditor, 09/1988
to 07/1991 Company Name – City,
Conducted field audits for acute care hospitals and related distinct part units; home health agencies, and long term care hospitals.
Experienced Staff Accountant, 07/1986
to 09/1988 Company Name – City,
Conducted financial audits of retail, real estate, and manufacturing clients.
Master of Science: Accounting,
Harding University - City,
Bachelor of Business Administration: Accounting,
Harding University - City,
State Accounting Cum Laude
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