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Manager Maryland Regulatory and Revenue Management

MedStar Health
United States, Maryland, Columbia
5565 Sterrett Place (Show on map)
Jul 11, 2025
General Summary of Position Performs and is responsible for various regulatory functions to maintain compliance with the mandates of the Health Services Cost Review Commission, a unique reimbursement system found only in Maryland. Manages up to 3 of the Maryland hospitals, which may vary throughout the annual cycle, for the HSCRC revenue and reimbursement reporting compliance. Manages the compilation, reconciliation and submission of the HSCRC all payor tape data unique to our Maryland reimbursement system. Manages the implementation of HSCRC methodology mandates for the Maryland hospitals. Primary Duties and Responsibilities Reviews, implements and is responsible for all HSCRC compliance methodologies including corridor compliance. Develops reimbursement, revenue, case-mix and budget models, working with IT and others, that incorporate all changes and new HSCRC policies and HSCRC reimbursement regulations. Validates and submits HSCRC tapes including working with IT, HSCRC and others to implement any changes to reporting criteria, resolve errors and implement new procedures. Develops and maintains HSCRC reports, working with IT and others that incorporate all revised and new HSCRC regulatory methodologies to include but not limited to Denials, Uncompensated Care, Statistical and Financial monthly, quarterly and annual reporting Acts as liaison for hospital issues with the HSCRC staff, maintaining a good working relationship Provides a review of the HSCRC Annual Filings and assists in completion as deemed necessary. Provides a review of the Medicare Cost Reports and assists in completion as deemed necessary. Completes HSCRC and Medicare audits Participates in MHA (Maryland Hospital Association) and HSCRC Task Forces as deemed necessary. Reviews monthly case-mix and volume reporting and identifies significant fluctuations to budget and monthly trend. Communicates with hospitals, accounting, management and other departments concerning any reimbursement related issues or changes and quantifies expected impact on reimbursement. Reviews and assists, as needed, on regulatory surveys and annual community benefit reporting. Selects, trains, orients, and assigns department regulatory staff. Develops standards of performance, evaluates performance, and conducts performance management planning. Initiates or makes recommendations for personnel actions and maintains ongoing communication with direct reports to review programs, provide feedback, discuss new developments, and exchange information. Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations. Responsible for management of snapshot data and resolving issues with St. Paul Computer Center. Responsible for Medicaid reporting as required based on the State Budget shortfalls or Medicaid expansion programs. Works with Coding Quality Director to prepare analytical financial schedules for APR DRG's. Responsible for management of snapshot data and resolving issues with St. Paul Computer Center. Responsible for providing information for Hospitals to complete Community Benefit Report and review of HSCRC Community Benefit Report to provide feedback to Corporate. Provide information as deemed necessary to Corporate related to the MedStar and IRS Community Benefit Report. Responsible for the review and strategic recommendations for the CPC inpatient methodology, CPV outpatient methodology, CPE inpatient readmissions methodology and Quality Initiatives (MHAC and QBR). Responsible for validation and submission of inpatient and outpatient HSCRC tapes including working with IT and HSCRC to implement any changes to criteria, resolve errors, and implement new procedures. Works with VP to resolve rate issues with HSCRC. Minimum Qualifications Education Bachelor's degree Accounting, Finance or other related field required Experience 1-2 years 2 years regulatory/reimbursement experience plus 2 years public accounting experience. required or 3-4 years 4 years of regulatory/reimbursement experience required Licenses and Certifications CPA (Certified Public Accountant) certification Upon Hire required Knowledge, Skills, and Abilities Verbal and written communication skills are necessary. Microsoft Technology (Excel, Access and Power BI) strong proficiency SQL, and significant database proficiency and or equivalent may be required This position has a hiring range of $111,779 - $212,513