Position Information

Reports To:  President & Chief Executive Officer

Position Summary:  Responsible for developing, evaluating, implementing and advocating the Association’s positions regarding issues of reimbursement and health care finance policy consistent with the Board’s goals and objectives; maintaining current knowledge of and can communicate Medicare and Medicaid laws, regulations, reimbursement principals, and methods; maintaining current knowledge of the State’s certificate of need (CON) process, and other long term care finance issues.

Responsibilities:

• Maintain and communicate knowledge of Medicare and Medicaid laws, regulations, reimbursement principles, and methods
• Maintain and communicate knowledge of Medicare and Medicaid reform efforts and alternative payment systems including knowledge of reimbursement systems utilized in other states
• Maintain and communicate knowledge of the Georgia Department of Community Health’s (DCH) Medicaid Management Information System (MMIS)
• Maintain and communicate knowledge of state waiver options and authorities and reimbursement systems for all provider types under those authorities (SOURCE and other home and community based services)
• Establish and maintain relationships with appropriate Divisions and Offices of the DCH (Medicaid, Financial Services, Reimbursement Services, Budget Office, etc.) and DCH’s fiscal agent (Gainwell Technologies, Deloitte) regarding Medicaid reimbursement policy; additionally establish and maintain relationships with DPH, with interactions including agents from DFCS, OFI, ABD
• Establish and maintain relationships, as appropriate, with the Department of Human Services Division of Aging Services regarding home and community based services
• Represent the Association, serving on state-led projects, work groups, and task forces, relating and/or impacting Skilled Nursing and Elderly & Disabled Waiver Program services
• Maintain and analyze Medicaid cost report data and other information from external sources to support financial analysis and reimbursement policy proposals
• Review legislation, the state budget, and Medicaid reimbursement plan modifications assessing potential implications on providers relative to reimbursement issues (develop and advise GHCA membership on the impact to individual facilities)
• Recommend changes to proposed reimbursement methodology and funding to assure adequate reimbursement rates
• Communicate all changes in reimbursement policy or methods as appropriate
• Serve as a member resource/advisor assisting in problem resolution or issue clarification
• Serve as a member resource/advisor for other issues including, but not limited to, Certificate of Need, Medicaid Eligibility
• Represent the Association, serving as liaison to the national affiliate regarding both state and federal reimbursement policy issues and proposed legislation
• Advise members on requirements of federal and/or state law for all reimbursement and financial issues affecting the financial operations of providers
• Serve as the liaison to the Reimbursement committee to support the development and execution of the Board’s reimbursement goals and objectives
• Actively monitor the State's development of Care Management Organizations (CMOs) which impact the Elderly and Disabled Waiver Program as well as those Medicaid recipients in the Skilled Nursing Home setting
• Serve as the liaison to the EDWCM Allied Membership
• Other duties and special projects as assigned by the President & CEO

Qualifications:

• Bachelor’s Degree in Accounting or a related discipline and 10+ years of experience in a reimbursement role, or an equivalent combination of education, training and experience related to the duties of the position
• Strong communication skills; communicates effectively, orally and in writing, as appropriate for the needs of the audience
• Ability to read, understand, interpret and discuss complex data and documents
• Ability to create complex data and documents and convey in writing complex ideas including, but not limited to, drafting proposed legislation and amendments to existing legislation
• Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
• Ability to analyze and consider the relative costs and benefits of potential actions and make appropriate recommendations
• Intermediate to advanced capability with database and/or spreadsheet software (Excel), word processing software (Word), and presentation software (PowerPoint)
• Ability to execute day-to-day tasks and work independently
• Strong leadership skills
• Ability to educate, train and mentor staff and Board
• Ability to prioritize and follow through effectively

This position is full-time salaried, commensurate with experience.
Office is located in Stockbridge, GA