Reimbursement Analysis - REMOTE

Major Responsibilities

• Aid in planning and preparing revenue analysis for system-wide programs, projects, and services.
• Monitor revenue budgets and benchmarking activities.
• Support all intermediary data requests, audits, and exit conferences.
• Prepare and provide necessary information for system-wide external financial audits and Medicare/Medicaid interim and year-end cost reports.
• Coordinate the year-end system financial audit with external auditors and reimbursement staff.
• Develop and maintain relationships with the Fiscal Intermediary and external auditors.
• Prepare analysis and make recommendations to ensure timely completion of regulatory reviews.
• Participate in the development and preparation of the system-wide budget for Gross and Net Patient Revenue.
• Analyze and review monthly accounts receivable valuations and provide recommendations for optimal reimbursement.
• Understand and oversee tools used for calculation.
• Develop and coordinate the system-wide monthly closing process for Medicare/Medicaid liabilities and allowances on patient receivables.
• Monitor processes to ensure accurate payment for Medicare/Medicaid and interim payments to determine accuracy, appropriateness, and potential liability.
• Request adjustments from United Government Services (UGS) and update internal systems.
• Develop and apply knowledge of Medicare and Medicaid regulations pertaining to current and proposed reimbursement.
• Work directly with Government Affairs and external consultants to provide needed expertise.
• Coordinate with the Financial Planning department to prepare System budgets related to third-party reimbursement.
• Provide support to Financial Planning in the development of retrospective financial reviews and pro forma development.

Requirements

• Licenses, Registrations, and Certifications: None Required
• Education: Bachelor's Degree in Finance or related field.
• Experience: Typically requires 3 years of experience in reimbursement, including experiences in preparation of Medicare/Medicaid cost reports, regulations, and analysis, modeling, and reporting of third-party payers.
• Knowledge, Skills & Abilities: Demonstrated expertise with Medicare and Medicaid regulations in a healthcare or federal intermediary setting; knowledge and understanding of third-party regulations and their interrelationship with financial statements to comply with regulations and maximize reimbursement rates; strong initiative and high-quality analytical results; strong accounting background with experience in preparing and/or reviewing healthcare financial statements; strong proficiency in Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools, or similar products; demonstrated ability to work in a complex environment; excellent written and verbal communication skills; self-motivated and capable of carrying projects to successful completion.

Physical Requirements and Working Conditions

• Must be able to sit the majority of the workday.
• Must be able to lift up to 10 lbs. occasionally.
• Operates all equipment necessary to perform the job.
• Exposed to normal office environment.
• This position requires travel, so exposure to weather and road conditions is expected.

Preferred

• Advanced Excel skills.
• Accounting skills.
• Healthcare experience.
• PowerBI experience.
• Analytics tools in Epic; Slicer/Dicer and/or Reporting Workbench.
• Accounts receivable experience.
• Ledger entry experience.