Reimbursement Manager​/GME

Overview

Responsible for management and evaluation of all systems required to provide MCWAH with information and documentation needed to optimize their GME and IME reimbursement. Work closely with affiliate Reimbursement Managers, Chief Medical Officers, Program Directors, Department Administrators, Residency and Fellowship Coordinators, and other staff to provide an effective, comprehensive GME reimbursement program. Work with the GME Department Administrator and DIO to research funding and FTE issues as needed.

Collaborate with staff to resolve funding, reimbursement, finance, and payroll questions. Work with the accounting staff and the financial auditors to help resolve any questions that arise.

Note:

This description is presented as a refined version of the original content and preserves the same responsibilities and requirements.

• Maintain a thorough knowledge of current and pending Centers for Medicare and Medicaid Services (CMS) rules and regulations concerning GME and IME reimbursement.
• Implement changes to existing systems as necessary to improve efficiency and effectiveness or to respond to changing CMS rules and clarifications.
• Develop, manage, and evaluate processes for standardized approaches to systems that will optimize GME reimbursement for the affiliated hospitals.
• Maintain effective working relationships with Department Administrators, Program Directors, and Education Coordinators for the 100+ MCWAH accredited residency and fellowship programs.
• Utilize the ACGME Accreditation Data System (ADS) in order to review program complements and hospital rotation sites.
• Develop a thorough knowledge of the Health Financial Systems (HFS) and the iRotations systems that are used to manage GME reimbursement reporting systems. Work as a liaison with vendors to address performance issues or to recommend needed changes.
• Learn and maintain the relationship between the affiliated hospitals and the residency/fellowship FTE they support.
• Become knowledgeable on program funding requests and obtaining approvals from key leadership as needed.
• Manage current systems regarding the quarterly flow of rotation and assignment information from the residency/fellowship programs. Evaluate and look for process improvements.
• Audit quarterly rotation submissions from the residency/fellowship coordinators. Train and oversee the work of the MCWAH staff that assist with the quarterly audits.
• Hold quarterly meetings with MCWAH staff to discuss the previous quarter’s audits.
• Monitor the results of CMS and HRSA audits at the affiliated hospitals and implement changes to address deficiencies in our current documentation practices.
• Provide training to all new program coordinators and MCWAH staff who will be using the iRotations collection system.
• Oversee the collection, analysis, dissemination, and maintenance of source documentation from our residency and fellowships that is needed by hospitals to meet their Medicare audit requirements.
• Manage and track the online record-keeping system to ensure audit-related documentation will be maintained and will be available to our hospitals in a timely manner.
• Create annual IRIS reports using HFS and provide these reports to the hospitals at the appropriate times.
• Maintain liaison with key hospital staff to discuss common issues concerning GME reimbursement.
• Provide additional documentation that may be requested by the Medicare Contractor. This could be support for FTE claimed, non-MCWAH rotators, duplicate FTE, ECFMG certificates, and more.
• Collaborate with VA and MCWAH staff to resolve any VA timesheet issues, complete the annual VA funding agreement, and review changes in FTE support requested from the programs.
• Provide analysis of future GME funding needs that are a result of requests from individual programs.
• Work with the affiliated hospitals consultants as needed.
• Manage other finance-related projects as requested by the DIO and/or GME Administrator.

• Strong working knowledge of clinic operations, reimbursement practices, procedure coding/use of modifiers and monitoring of reimbursement trends.
• Ability to handle multiple tasks…