The Finance Manager, HMO Reimbursement manages the day to day financial activities for the Medicare HMO Reimbursement line of business. The position is accountable for the Medicare HMO Cost Report regulatory filings, compliance to CMS reimbursement regulations and reimbursement financial reporting for the HMO cost based regions (MAS, OH, NCAL, SCAL, and HI). The Finance Manager provides management and oversight of the HMO Reimbursement team and supports National Medicare Finance initiatives. This position is located in Rockville MD.
- Provides financial management of the Medicare HMO Reimbursement activities
- Manages the day to day activities of the HMO Reimbursement team. Sets performance expectation, develops annual Reimbursement team goals and objectives and performs mid-year and annual performance evaluations of the HMO Reimbursement staff.
- Responsible for the accurate and timely filing of the annual Medicare HMO Cost Reports, and additional interim cost reports as required as CMS. Ensures compliance with CMS regulations.
- Ensures the timely processing of transactions and data for the accurate and timely issuance of reimbursement revenue and reserve estimates and financial results. Works with other financial and non-financial staff to accomplish accurate and timely financial reporting in accordance with generally accepted accounting principles.
- Develops, monitors, and updates appropriate Medicare reimbursement reserves.
- Responsible for the management and remediation of reimbursement regulatory financial issues, including monitoring of compliance with key regulatory financial reporting requirements.
- Develops awareness and accountability within NMF, NMF's key business partners and in HMO cost regions on all aspects of HMO Cost Reimbursement to ensure that reimbursement revenue is accurately recorded and reported, and in compliance with CMS regulations
- Responsible for monitoring the integrity, accuracy and completeness of data (including required disclosures) of financial information utilized in the HMO reimbursement area and information provided to the regions, Program Office, regulators and auditors.
- Responsible for the development, implementation, monitoring, remediation, and enhancement of NMF control systems in the HMO Reimbursement area including: training of personnel; periodic evaluation and monitoring of control systems; oversight of corrective action plans to remedy control weaknesses identified; and involvement in control design considerations of systems under development.
- Coordinates the development and implementation of financial policy related to HMO cost report reimbursement.
- Responsible for reviewing responses and documents for the HMO Cost Report audits. Coordinates audit request at the regional level for external, internal, and regulatory financial audits with the NCO, NMF Accounting and Audit teams. Remediates of audit findings in the HMO reimbursement area.
- Responsible for staff development of the HMO Reimbursement team. Builds skills and capabilities to enhance performance of the team. Shares knowledge, provides coaching and mentoring, and contributes to the learning of others.
- Maintains current knowledge of changes in Federal Medicare Reimbursement regulations and requirements.
- Leads, directs, and participates cross regional/national work teams as necessary.
- Promotes sharing and implementation of best practices both regionally and nationally.
- Manages the resolution of diverse and complex issues where analysis of situations or data requires an in-depth knowledge of multiple functions and KP objectives.
- Two (2) or more years of management experience and five (5) or more years of related experience
- Four (4) year degree in related field or equivalent experience
- Requires full knowledge of own area of functional responsibility and working knowledge of another function
- CPA / CMA
- Master's degree in related field
- Experience in compliance activities
- Strong understanding of systems and data sources
- Knowledge of federal laws and regulations governing Medicare reimbursement
- Five or more years of reimbursement experience
- Management skills and experience in managing goals through collaboration and teamwork
- Experience with development and performance management of a team of two or more
- Demonstrated ability to lead financial reporting and financial variance analysis
- Demonstrated ability to coordinate with regional and national peers/stakeholders and manage multiple projects, and manage to metrics
- Experience with working large data sets, operational data and with health care statistics
Kaiser Permanente - 10 months ago
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