A Bachelor's Degree in Finance, Healthcare Administration, Information Technology or related field is desired. The equivalent combination of certifications, training, and 5 -10 years experience may be considered.
Experience in healthcare to have developed extensive knowledge in the proper application, compliance and treatment of health care operational activities, Medicare and Medi-Cal Laws and Regulations governing facility entitlements under Title XVIII and Title XXII as is typically obtained in 5-7 years. In addition, experience required for this position includes the following:
• Demonstrated ability to read, research, interpret and implement government laws and regulations and changes thereof.
• Must have demonstrated experience in the preparation and completion of Medicare and Medi-Cal Cost Reports.
• Must have the ability to coordinate and work with Medicare and Medi-Cal Auditors, as well as be knowledgeable in both Medicare and Medi-Cal audit and appeal processes.
• Must have demonstrated experience in preparing Medicare and Medi-Cal audit appeals position papers and documentation that meets all requirements as stipulated by Medicare and Medi-Cal regulations governing the Appeal Procedures.
• Must have directed the preparation of the annual Medicare and Medi-Cal cost report, and the California Annual Hospital Financial Disclosure Report (OSHPD)
• Must be knowledgeable and have performed and/or developed calculations of contractual allowance amounts recorded in the Hospital’s general ledger.
• Required the ability to performed routine product reviews to identify issues and improvements.
• Required the ability to process data for analysis (cleansing, modifying, and formatting) and mapping data across various systems
• Required the ability to compile periodic reports with metrics by product, detailing issue category, frequency, cause, preventive recommendations and trends.
• Required the ability to provide QA support by finding data problems in any data repository including spreadsheets and spreadsheet formulas and SQL Server tables.
• Required the ability to read/modify/create complex T-SQL queries, SP’s as needed.
• Must be knowledgeable and thoroughly understand the various Medicare and Medi-Cal cost reporting and compliance requirements.
• Must be knowledgeable in both old and current Medicare and Medi-Cal Laws and regulations governing reimbursement related to Acute Hospitals, Psychiatric Hospitals, Rehabilitation Unit, Skilled Nursing Facilities, Rural Health Clinics, Inpatient and Outpatient pay system, Medi-Cal payment system and regulations under Title XXII.
• Must be knowledgeable and understand the California Annual Hospital financial Disclosure reporting process and requirements.
• Must have thorough knowledge of the hospital accounting system, audit processes, workpapers presentation, computer skills, and automated Medicare/Medi-Cal cost report software.
• Must be knowledgeable in the use of personal computer and its applications, such as: spreadsheet, word-processing, and cost reporting software application.
• Must be proficient and know how to write brief and concise reports.
• Must be knowledgeable in creating and developing workpapers with supporting documents to establish audit trails to support cost report data.
• Must know and understand how to apply statistical methods.
• Must be able to perform and complete work assignments effectively and accurately with very minimal direction and supervision.
• Design, build and maintain custom solutions in order to streamline the department’s current workflow/processes and improve efficiency. Evaluate current processes and make recommendations when significant improvements can be achieved through the use of automation.
• Create custom reports using MS SQL Server, MS Reporting Services, Crystal Reports 2008 and Excel.
• Evaluate complex database schemas and query data using advanced T-SQL techniques to support the reporting and application needs of the department.
• Database design & maintenance.
• Must have excellent organizational, analytical and planning skills.
• Must have demonstrated leadership, adult training and education skills.
• Must have ability to determine reasonableness of data acquired from various sources.
• Must have excellent written, verbal and interpersonal and presentation skills.
• Must be able to work with all levels of management and translate complex rules and regulation issues, requirements to non-reimbursement staff at the facility level.
• Must have the ability to constantly maintain a professional working relationship with various personnel during difficult situations.
• Must possess the skill to negotiate and persuade when needed.
• Must have the ability to handle shifting priorities and multiple projects independently and simultaneously.
• Must be able to work independently with very minimum supervision.
• Must have the ability to read and interpret government regulations.
• Must have the ability to work on various assignments (example: 3-5 hospital cost reports at one time) and adhere to critical deadlines.
• Must be knowledgeable and proficient in the use of Personal Computers, spreadsheets and word-processing software, and cost report software
• Must have a valid California Drivers License.
• Excel skills with a working knowledge of advanced table and graph/charting functions.
• Experience with SQL, T-SQL, PL-SQL, SSIS, SSRS
• Experience with ETL processes
• Experience with developing new databases with the ability to create and modify System Tables, Views, Stored Procedure and Functions
• Experience with Indexes, Triggers and Keys
• Experience with Visual Studio, Visio, and Crystal Report, UltraEdit
• Experience with system and database migration
• Experience with Data Profiling and Data Segmentation
• Knowledge of SQL Server Databases
• Must be able to sit and work at a computer for extended periods of time (5-8 hours daily).
• Must be able to travel throughout Northern California with some overnight stays out of town.
• Must be able to adapt and work in areas while working on-site at the facility.
• Must be able to lift weights (5-30 lbs.) to carry workpapers files, retrieve various documents.