Analyst, Reimbursement III

About the Role

The Reimbursement Analyst III prepares hospital, hospice, home health agency, home office, and skilled nursing facility cost reports. This position supports the annual external audit related to net revenue valuation, net accounts receivable valuation, and pay or settlement liabilities. It also maintains and audits the decision support system reimbursement modeling to ensure calculated net revenues align with actual payments. Additional responsibilities include special analysis related to patient services, government regulatory issues, and general accounting.

Responsibilities

• Evaluation of Net Patient Services Revenue and Accounts Receivable (10%)
  • Monthly analysis and valuation of net patient services revenue
  • Interim updating of Medicare and third-party settlement liabilities
  • Quarterly evaluation of net patient accounts receivable and adjustments as required
  • Serve as an external audit resource for documentation related to net patient revenue and net patient accounts receivable valuation
• Medicare Cost Report Preparation and Audit Support (50%)
  • Prepare cost reports for Regions and HealthPartners affiliates
  • Assist the Reimbursement Manager with Medicare audit support as needed
  • Assist with the preparation of Medicare appeals
  • Prepare documentation and position papers as needed
• Decision Support System Modeling and Analysis (10%)
  • Modeling of Net Revenue Reimbursement for Medicare & Medicaid
  • Auditing of Decision Support System reimbursement and costing
  • Analysis of regulatory and program changes using the decision support system
• Other Regulatory Reporting (20%)
  • File the annual Department of Health Hospital Annual Report based on existing State of Minnesota regulations
  • File the annual Department of Health Medical Education and Research Cost grant application based on existing State of Minnesota regulations
  • Complete trade association survey data related to patient services revenue and statistical data from regular analytical records
• Preparation of Annual Net Patient Services Revenue Budget and Associated Other Operating Revenues (10%)
  • Prepare assumption-driven inpatient and outpatient gross revenue, contractual allowance, and net patient services revenue budget based on historical data and business volume changes
  • Prepare analysis for mid-year forecasting of net revenue

Requirements

• Bachelor’s degree in Accounting or Finance
• 3–5 years of experience in Medicare cost reporting or related healthcare finance area

Skills

• Advanced knowledge of hospital accounting and Medicare cost accounting fundamentals
• Knowledge of accounting, statistics, and general business principles and practices
• Ability to maintain effective working relationships with others
• Strong written and oral communication skills
• Ability to handle confidential information with discretion
• Proficiency in Microsoft Office (Excel, PowerPoint), cost report preparation software, and personal computer use
• Ability to work independently with light supervision
• Advanced knowledge of third-party reimbursement payment mechanisms and settlement procedures
• Knowledge of hospital payor relationships and accounting