Uses internal and external data and resources to functionally manage and perform the federal and state Medicare and Medicaid enrollment and revalidation processes for BMHCC hospitals, BMG groups, surgery centers and other regulated entities.Maintains knowledge of business related changes in enrollment requirements for other programs such as retail pharmacy and quality reporting as determined appropriate for a project.Completes statistical analysis with various software and produces reports. Using initiative under general direction of Department Director, participates in governmental and strategic activities of the Department including project planning, Certificate of Need (CON) development, and federal and state certification/licensing.Researches and analyzes issues as assigned and prepares reports, charts, tables and narrative descriptions. Work requires continuous attention to technical detail.Performs all duties as assigned.Responsibilities
Requirements, Preferences and Experience Education
- Builds databases with corporate legal disclosure information for BMHCC related entities and confidential information for Board members, officers and managing employees. Manages the functional processes and completes enrollments with Medicare 855A and 855B in PECOS and handles projects such as Retail Pharmacies to provide information that is required for Medicare Part D. Manages state Medicaid enrollments for TN, MS and AR and other specific states as needed. Completes commercial enrollments for companies that offer Medicare Alternative products. Supports completion of other types of disclosures with regulations related to state and federal payer requirements. Ensures that the information is accurately, timely and securely submitted and follows until approved. Maintains ongoing knowledge of technical developments in new processes and applies knowledge of interactive online programs such as Medicare PECOS, CMS I&A Management, MCO contractors and state systems as well as traditional paper enrollments as required.
- Assembles data and information and develops reports for external presentation in CON applications, annual reports, surveys and other documents. Manages and executes projects including subpoena responses with Director and other colleagues. Identifies best available data sources. Applies appropriate software tools and completes analyses and reports including narrative, tables and graphical formats.
- Compiles information for development of new proposals. Participates in research, identification and analysis of trends including related legislative and regulatory issues. Maintains library of reference sources for current regulations, planning references, forms and other materials related to CON and other regulatory process requirements.
- Provides education/outreach for users such as new residents in Baptist Graduate Medical Education programs. Discusses CMS electronic process including Identity and Access Management, NPPES and PECOS. Performs unique enrollment needs such as providing W9 information for claims transactions with payors.
- Evaluates accuracy and completeness of reports received from internal sources and from contractors according to specific requirements of each type, before submitting to external agencies.
- Develops or acquires and maintains databases for entities including related legislative and regulatory activity and confidential management personnel information.
- Performs other duties requiring initiative for departmental relationships with individuals, state and federal agencies and professional associations.
- Completes assigned goals and performs other duties as required.
Preferred: Additional training in concepts related to healthcare preferred. Formal program completion and additional extended courses in healthcare beneficial. Exposure to healthcare service line management very helpful.
Minimum: Bachelor's degree or equivalent formal training or certification with work experience in business discipline, planning, public policy or related field required. Familiarity with analysis and ability to use database software including Access, Excel, Word, Visio and Adobe for data analysis, report development, visual presentations and formatting.Experience
Preferred: Experience preferably in healthcare setting involving governmental operations or regulatory issues strongly preferred. Exposure to enrollment of entities in federal programs such as Medicare and Medicaid and basic knowledge of prospective payment system terms and operations very helpful. Previous experience with health planning and Certificate of Need ideal.
Minimum: Three years experience required in business work requiring attention to detail with analytical, written and oral communication skills to explain a broad range of activities in clear terms for various publics. May include related work during formal education such as work/study program and internship.Special Skills
Preferred: Prefer that capabilities are demonstrated through previous and current activities or additional coursework indicating interest in continuing education to stay current.
Minimum: Ability to work with attention to details in reviewing state and federal reports and entering confidential information to assist the director with various regulatory planning and CON development, reporting, Federal and State licensing/certification, legislative and other public policy activities.Training
Preferred: Interest in learning systems, organizational structures and measurement of healthcare systems operations, along with the impact of regulatory/legislative interventions preferred. Knowledge of general computer software programming protocols preferred.
Minimum: Training to effectively use software packages available through BMHCC requires basic knowledge of computer systems and software obtained through formal education. Other training after employment will be associated with special projects related to healthcare operations and regulatory processesAbout Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.At Baptist, We Offer:
- Competitive salaries
- Paid vacation/time off
- Continuing education opportunities
- Generous retirement plan
- Health insurance, including dental and vision
- Sick leave
- Service awards
- Free parking
- Short-term disability
- Life insurance
- Health care and dependent care spending accounts
- Education assistance/continuing education
- Employee referral program
Position: 5731 - Manager-Regulatory Information Management
Facility: BMHCC Corporate Office
Department: HS Government Operations Corporate
Category: Leadership & Administration
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Located in the Memphis metro area