Cost Reporting & Rate Setting Manager

Under the general direction of the Assistant Director or designee, the Cost Reporting and Rate Setting Manager is responsible for all cost reporting activities for the unit as well as calculating and setting payment rates for health care services.  This entails the management of data analysts and consultants along with the production of work papers supporting the yearly CMS and state cost reports for 18 state operated facilities.  The different report types are listed below.

CMS – 2552, 2540, 2088

CHIA (State) – 403, ICF, HCF-1

OSD (State) – UFR

The manager is also responsible for overseeing rate setting activities for those facilities as well as recommending Medicaid claiming rates for community based programs including those for rehabilitative and home and community based services authorized by an approved Medicaid Waiver.    

The Provider Rate and Administrative Cost Reimbursement Unit (PRACRU) within the Center for Health Care Financing produces the quarterly Medicaid administrative claims on behalf of the University and completes Medicare/Medicaid cost reports, calculates rates for community based programs, computes  unreimbursed costs for state hospitals, and recommends upper payment limits for certain state owned services. These responsibilities are performed on behalf of the Executive Office of Health and Human Services (EOHHS) in accordance with an interagency agreement. 

• →Responsible for  the management of cost reporting activities including compiling, preparing, reviewing and submitting all required reports for all state owned non-acute hospitals, clinics, nursing facilities, and soldiers’ homes.
• →Calculate payment rates for health care services at state owned non-acute hospitals and community-based programs.
• →Compile, prepare, review and submit Cost Allocation Plans for health and human services agencies, as needed.
• →Develop, implement and evaluate program goals and objectives.
• →Responsible for the calculation of unreimbursed costs at state owned non-acute hospitals.
• →Responsible for the calculating and recommending of the upper payment limits for state owned and operated services.
• →Interview, make hiring recommendations, train, supervise and evaluate staff.
• →Manage workflow and priorities.
• →Prepare performance management reports.
• →Monitor contract services and provide feedback about the quality of vendor’s work.
• →Identify and apply best business practices.
• →Collaborate with the staff of the Office of Medicaid, EOHHS, state agencies and other organizations to  provide optimum client services in accordance with the service agreement.
• →Write, review and maintain business documents including reports, contracts, manuals, procedures and presentations
• →Participate in and implement continuous quality improvement initiatives such as an internal control plan and procedure manuals.
• →Promote compliance with state and federal rules and regulations.
• →Work independently and as a team member and leader.
• →Preserve confidential information and files.
• →Perform additional duties as required.

• Bachelor's degree in Finance, Business Administration or a related field
• 7 years' experience in fiscal management, finance, public administration or health care; with at least two years of demonstrated supervisory experience
• Knowledge of accounting principles, budgeting and financial report preparation.
• Experience in financial management.
• Proven management abilities in a complex environment.
• Proven ability to prioritize and coordinate multiple tasks and meet competing deadlines.
• Intermediate Microsoft Excel and Microsoft Office skills.
• Ability to travel to off-site locations.

• Master's degree in Finance, Business, Public or Health Care Administration or a related field
• Knowledge of state information systems such as the Massachusetts Management Accounting and Reporting System (MMARS) and Cognos.
• Advanced Microsoft Excel and Access software skills.
• Knowledge of state and federal rules and regulations as related to health care finance.
• Knowledge and experience with Meditech and other patient accounting systems.
• Knowledge of Medicare/Medicaid cost reporting and accounting.