Raymond Johnson Email & Phone Number

Raleigh-Durham, North Carolina Area

Responsible for the preparation and implementation of Cost Allocation Plans (CAP) for numerous county, city, and state Agencies. This includes leading efforts to develop Department-wide cost allocation plan, writing CAP Recommendation Reports, preparing CAP Narratives, and identifying allowable costs to allocate across the Agency’s departments for reimbursement through various federal and state funding sources. Duties also includes interviewing appropriate departmental personnel, reviewing financial documents & organizational structure, examining time study materials, and performing analysis of statistical data relative to benefit of services provided. Assisted in the implementation of our web-hosted cost allocation software, AlloCAP for the department to process quarterly CAP claims. Also lead efforts to perform a business review process for Clark County, Nevada Department of Social Services to re-write a Policy Manual and Procedures Manual. Other clients include: State of Pennsylvania City of Philadelphia, State of Oklahoma Health Care Authority & Department of Mental Health and Substance Abuse Services, State of Michigan Department of Human Services, and Michigan Department of Human and Health Services. Performed quality control review on the drafted Medicare (CMS-2552) and Medicaid (CHIA-403) cost reports on behalf of over 22 facilities from the Department of Public Health, Department of Mental Health, Department of Developmental Services and Soldiers’ Homes in Massachusetts and for the Department of Mental Health in the state of Missouri. Obtained specific information from the facilities in order to properly analyze detailed charges, revenue, and expenditures; completed a thorough review of all expenditures to ensure that all allowable costs were captured and reported in the cost reports; and conducted an analysis of the current rates set for Medicaid services and the current Disproportionate Share Hospital (DSH) calculation for the state facilities.

Chapel Hill, North Carolina

This position is to ensure that Medicare and Medicaid requirements are fulfilled by validating the Advanced Practice Providers’ (APP’s) time reported monthly via auditing the hospital’s TimeTrex system. Duties include acquiring and evaluating information relative to APP’s job functions and verifying that categorization of time is in compliance with the Centers for Medicare & Medicaid Services (CMS) regulations. This position requires shadowing of APP’s as well as written and verbal communications while working alongside other staff members. Additional responsibilities include assistance in the completion and submission of the Medicare and Medicaid Cost Reports and Home Office Statements. This includes collecting, reviewing, calculating, and verifying data associated with the numerous cost report worksheets, followed by the preparation of reports for the inputting of information into the cost reports. Also responsible for the attestation of provider-based clinics and ensuring that criteria are met for billing and payment purposes as required by CMS.

Raleigh, North Carolina Area

Responsible for the performance & supervision of Medicaid audits for the State of North Carolina. Facilities include: state-owned psychiatric hospitals, state-owned teaching hospitals, Rural Health Clinics (RHC), Intermediate Care Facilities/Mental Retardation (ICF/MR), Federally Qualified Health Centers (FQHC), and non-state acute hospitals. Also assist state governments in conducting research and analysis of various health care issues. Internally provide staff training, supervisory reviews, mentoring, and evaluations.

Raleigh, North Carolina

Responsible for the performance & supervision of Medicaid audits for the State of North Carolina. Facilities include: state-owned psychiatric hospitals, state-owned teaching hospitals, Rural Health Clinics (RHC), Intermediate Care Facilities/Mental Retardation (ICF/MR), Federally Qualified Health Centers (FQHC), and non-state acute hospitals. Also assist state governments in conducting research and analysis of various health care issues. Internally provide staff training, supervisory reviews, mentoring, and evaluations.

Medford, Massachusetts

This senior position is solely responsible for the completion and submission of the Medicare Cost Report and Massachusetts State Cost Report. Other reports include: HCFA91 PIP Interim Review; Research Indirect Cost Proposal; Quarterly Surcharge Payment Report; and the Unmatched Surcharge Payers Report Schedule. Cambridge Health Alliance, which is affiliated with Harvard Medical School, is a teaching facility with a Psychiatric Unit and Skilled Nursing Facility. Exclusively in charge of:• Collection and analysis of expenses, revenues, miscellaneous income, capital, and statistical data.• Calculating and verifying Interns & Resident’s full-time equivalents for Indirect Medical Education (IME) & Graduate Medical Education (GME) in conjunction with the preparation of the IRIS listing.• Preparation and input of information on all applicable cost report worksheets, including: Patient Statistics, Expenses, Wage Index, Reclasses, Adjustments, Provider-based Physicians, Statistics, Revenues, Settlement, IME/GME, Balance Sheet, and Income Statement.

Charlestown, Massachusetts

Primarily responsible for the preparation and submission of the Home Office State report and the Home Office Medicare cost report. Also, assist in the preparation and filing of the Medicare cost reports for Partners’ member-hospitals: acute, rehabilitation, and psychiatric facilities. Overall requirements include:• Perform monthly analysis of the P&L and Balance sheet activity; ad hoc analysis of issues to support management inquiries for revenue and expenses; budget/forecasting analysis; calculations for various reimbursement rates and limits; and account analysis to ensure data integrity.• Development and interpretation of expense trends, and interpretation and application of HCFA regulations to ensure greatest reimbursement impact for hospitals.• Assist with the coordination and process of audits.

Pittsburgh, Pennsylvania

The nature of this position is to perform routine aspects of auditing Medicare Cost Reports under HCFA regulations and GAAP guidelines. Responsibilities include supervising and conducting audits of different types: Hospitals, Skilled Nursing Facilities, Mental Health Facilities, Home Health Agencies, Comprehensive Outpatient Rehabilitation Facilities, and Ambulatory Surgery Center. Major areas of auditing include Graduate Medical Education, Indirect Medical Education, Bond Refinancing, Provider-Based Physicians, Funded Depreciation, and Interest. Duties involve:• scoping audits; writing and reviewing policies & procedures, interpreting Medicare regulations and policies;• analyzing financial reports, cost reports; testing claims, invoices; verifying supporting documentation; • preparing and presenting computerized adjustment and settlement reports.