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Reimbursement Associate Team Lead (Harrisburg)

  • Job ID: 565078219
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: Monday to Friday, 8:00 a.m. to 4:30 p.m.
  • Shift: Day Job
  • Facility: Pinnacle Health Support Services
  • Department: Revenue Integrity
  • Location: 409 South Second Street, Harrisburg PA 17104
  • Union Position: No
  • Salary Range: $30.12 to $46.71 / hour

Description

Purpose:
Under the direction of the Director of Reimbursement, the Reimbursement Associate Team Leader is primarily responsible for assisting the Director in monitoring the development and realization of reimbursement for UPMC Pinnacle Hospitals. The Team Leader will monitor usage by Hospital departments to ensure that reimbursements are adequate for and appropriate to services provided; monitor new and/or proposed Federal regulations concerning Medicare/Medical Assistance and to determine the future financial impact. Annually, the Team Leader will oversee and participate in the completion of the Medicare and Medical Assistance cost reports for UPMC Pinnacle Hospitals and Pennsylvania Psychiatric Institute, along with the UPMC Pinnacle Health System Home Office report.This position serves as the primary support person for the Department's Reimbursement Associates and will manage the day-to-day work flow.

This position will work a 40-hour workweek from Monday to Friday, with flexibility of hours. 

Responsibilities:

 

  • Reimbursement Analysis: Analyze changes in regulations impacting reimbursement to determine impact on UPMC Pinnacle financial position and operations. This involves taking a proactive stance in seeking out regulatory changes, analyzing them, making recommendations to management related to compliance, operational changes, and billing changes. Remain up-to-date on reimbursement issues. This involves monitoring the Federal Register and other government documents for reimbursement related issues. Reviewing, understanding, and evaluating their impact, communicating with executive management and other departments affected by the changes. Support system management with financial analysis of reimbursement impact of new programs proposed for UPMC Pinnacle.
  • Cost Reports and Third Party Audits: Maintains current knowledge of regulatory issues affecting reimbursement and cost reporting. Proactively researches new regulations to determine necessary revisions to cost reports. Monitors accounting and financial changes that will affect cost report preparation. Continuously evaluates and improves process utilized in cost report preparation. Gathers related data timely, throughout the fiscal year. Educates system management on reimbursement issues and cost reporting issues. Ensures cost report complies with regulatory guidelines. Ensures audit adjustments from prior year cost reports are handled appropriately in subsequent years. Performs detail and overall review of all cost report schedules, forms, and supporting documents. Ensures accurate completion of cost reports within regulatory time frames. Coordinates third party audits providing requested supporting documents and other information in a timely manner. Reviews all third party audit adjustments and settlements for propriety and works with Medicare Administrative Contractor to resolve differences. Evaluates reimbursement impact of settlements and ensures proper accounting for NPRs and other settlements. Coordinates formal appeals and reopening when necessary.
  • Human Relations / Contact and Communications: The Reimbursement Associate Team Leader will have contact with all levels of management within UPMC Pinnacle. This position requires the ability to work effectively with staff and management of UPMC Pinnacle.

 

Qualifications

Required Knowledge, Skills and Abilities:

  • Bachelor of Science in Accounting
  • Minimum of 5 years experience in hospital reimbursement
  • Extensive knowledge of reimbursement principles and their impact on operations
  • Knowledge of generally accepted accounting principles
  • Expert knowledge with information systems utilized in the reimbursement area, including cost report and spread sheet software (i.e. Excel & Access) 
  • Well organized with strong managerial skills
  • Effective communications skills, both oral and written
  • Strong problem solving skills to approach situations in an imaginative, innovative, interpretive and analytical manner.

    Preferred Knowledge, Skills and Abilities:
  • Knowledge of CPT and HCPCS coding
  •  Knowledge of hospital billing rules


Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days
 

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct