Reimbursement Specialist - Healthcare jobs in Baton Rouge, LA

JOB PURPOSE OR MISSION

Manages and coordinates the functions and activities related to General Health System governmental reimbursement.

PERFORMANCE CRITERIA

CRITERIA A: Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.

PERFORMANCE STANDARDS:

• Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.

• Takes initiative in living our Everyday Excellence values and vital signs.

• Takes initiative in identifying customer needs before the customer asks.

• Participates in teamwork willingly and with enthusiasm.

• Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.

• Keeps customers informed, answers customer questions and anticipates information needs of customers

CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines and the GHS Corporate Compliance Guidelines.

PERFORMANCE STANDARDS

• Practices diligence in fulfilling the regulatory and legal requirements of the position and department.

• Maintains accurate and reliable patient/organizational records.

• Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.

CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.

PERFORMANCE STANDARDS

• Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.

• Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.

• Upholds the ethical standards of the organization.

CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.

PERFORMANCE STANDARDS

• Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.

• Initiates or redesigns to continuously improve work processes.

• Contributes ideas and suggestions to improve approaches to work processes.

• Willingly participates in organization and/or department quality initiatives.

CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.

PERFORMANCE STANDARDS

• Effectively manages time and resources

• Makes conscious effort to effectively utilize the resources of the organization — material, human, and financial.

• Consistently looks for and uses resource saving processes

CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.

PERFORMANCE STANDARDS

• Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.

• Employee proactively reports errors, potential errors, injuries or potential injuries.

• Employee demonstrates departmental specific patient and employee safety standards at all times.

• Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.

JOB FUNCTIONS

ESSENTIAL JOB FUNCTIONS include, but are not limited to:

1. Ensures accurate and timely completion and settlement of all required cost reports.

PERFORMANCE STANDARDS:

• Coordinates and manages cost report completion process including interactions with outside consultants.

• Responsible for insuring that appropriate settlements are made by the fiscal intermediary and are recorded properly.

• Keeps current with reimbursement topics at both the state and federal levels.

2. Creates and coordinates all information-gathering processes related to cost report completion and related audits.

PERFORMANCE STANDARDS:

• Develops and manages processes to collect required data within other GHS finance departments, other GHS operational departments, and outside data sources such as governmental agencies.

• Corresponds and interacts with intermediaries to collect required data such as NPRs.

• Attends meetings as required and participates on committees as directed/requested.

• Maintains current knowledge of reimbursement trends/regulations/legislation through reading, training, seminars, professional affiliations, etc.

3. Ensures accurate and timely production of governmental contractual allowance estimates for internal financial reports.

PERFORMANCE STANDARDS:

• Reviews estimates of contractual allowances and adjustments for monthly and annual financial statement purposes.

• Performs quarterly tests of balance sheet accounts.

• Designs new contractual allowance-related tools as necessary.

• Updates reimbursement factors quarterly.

4. Performs financial analysis/modeling to support decision-making.

PERFORMANCE STANDARDS:

• Works with management to determine impact of proposed or recently enacted changes in governmental reimbursement and alternate operating and financial structures.

5. Performs all other duties as assigned.

EXPERIENCE REQUIREMENTS

Direct healthcare reimbursement experience, or experience in healthcare finance with exposure to governmental reimbursement preferred.

EDUCATIONAL REQUIREMENTS

Bachelor’s Degree

HIPAA REQUIREMENTS

Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position including but not limited to: medical record w/limitation to job function both paper and electronic, patient demographic information, patient financial and/or 3rd party billing information, research information.

SAFETY REQUIREMENTS

Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: incident reporting, exposure control plans, hand washing, and environment of care.