Cost Report Reimbursement Manager at Abarca Health

Sioux Falls, South Dakota, United States

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$90,480 – $135,200Compensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's degree in Accounting, Business, Finance or related field
4-6 years experience in the healthcare environment with regulatory and cost reporting experience
5+ years of Medicare Cost Reporting experience
Visual acuity adequate to perform position duties
Ability to communicate effectively with others, hear, understand and distinguish speech and other sounds

Responsibilities

Oversight of reimbursement associated with Medicare, Medicaid, Tricare and other governmental cost reports for Avera Health hospitals, clinics, home healths, hospices, and nursing homes
Completion of the monthly Medicare 3rd Party Settlement calculation for all hospitals
Assist in the development and calculations of the annual revenue deductions and uncompensated care budget for all Avera hospitals, clinics, and nursing
Manage and maintain workflows for filing and review of Medicare, Medicaid and Tricare cost reports for the assigned Avera region
Maintain oversight of the collection of cost report information for assigned locations and oversight of governmental audits of all facilities
Complete all requests for data and support documentation during the annual audit of financial statements for the 3rd party reserves for all Avera Health hospitals
Monitor and interpret state and federal regulatory publications and announcements, providing impact analysis for all Avera hospitals, clinics, nursing homes and other patient operating units
Provide expertise, guidance, and advice to the rural network on reimbursement issues and cost report impacts as requested
Act as the financial liaison to stakeholders in all Avera regions regarding reimbursement matters/issues, general compliance, and charge master compliance relative to Medicare cost reporting
Collaborate with Finance, Decision Support, and the Revenue Cycle by offering direction/guidance on reimbursement issues/concerns

Skills

Medicare Cost Reporting

Medicaid Cost Reports

Tricare Cost Reports

3rd Party Settlement

Revenue Deductions

Uncompensated Care

Governmental Audits

Regulatory Analysis

Financial Audits

Workflow Management

Abarca Health

Pharmacy Benefit Management services provider

About Abarca Health

Abarca Health provides Pharmacy Benefit Management (PBM) services, focusing on flexible and user-friendly solutions for health plans, employers, and government programs like Medicare and Medicaid. Its main product, the Darwin platform, allows clients to quickly implement and modify benefit designs while ensuring compliance with regulations. Abarca Health manages over $5.3 billion in drug spend and processes 100 million prescription claims annually, offering additional services like home delivery for prescriptions. The company's goal is to deliver exceptional service and innovative solutions in the PBM market.

Aventura, FloridaHeadquarters

2005Year Founded

VENTURE_UNKNOWNCompany Stage

HealthcareIndustries

501-1,000Employees

Benefits

PTO

Parental leave

Work flexibility

Health insurance

Wellness stipend

401k

Tuition reimbursement

Leadership development programs

Risks

Increased competition from Amazon Pharmacy and Mark Cuban's Cost Plus Drug Company.

Growing focus on specialty drugs may require platform adaptation.

Shift towards price transparency could pressure Abarca's pricing models.

Differentiation

Abarca Health's Darwin platform is highly adaptable and user-friendly.

The company offers innovative programs like Triple S en Casa for home delivery.

Abarca Health ensures compliance with ever-changing healthcare regulations.

Upsides

Abarca transitioned two million members to Darwin in 18 months, showing operational efficiency.

Collaboration with Blue Shield of California boosts Abarca's reputation in the PBM sector.

Recognition as a top IT workplace attracts top talent, driving innovation.

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