Reimbursement Analyst Senior

About the role

The ideal candidate has experience in preferred systems: Office Connect, OneStream, Strata, & Excel. Candidate also has an interest in data transformation initiatives.

Responsibilities

• Plans and prepares revenue analysis for system wide programs, projects and services, and monitors revenue budgets and benchmarking activities.
• Identifies and researches opportunities to enhance revenue and improve administrative efficiency of governmental payor programs.
• Works with the Manager of Reimbursement in conjunction with financial and operational leadership to implement the opportunities identified.
• Reviews government agency bulletins, publications, and the Federal Register to understand proposed and actual state and federal government statutory and regulatory changes that impact Aurora and analyzes the financial and operational impact of the changes to Aurora.
• Develops a plan to communicate the impact of the statutory and regulatory changes to finance and operational leadership.
• Counsels Aurora’s response to government agencies on proposed rulemaking and assists with making necessary operational changes to maximize Aurora’s reimbursement under these government programs.
• Serves as one of the Aurora representatives on the state Medicaid Hospital Rate Advisory Group, Health Care Quality Coalition, and Wisconsin Hospital Association Medicaid Advisory Group.
• Participates regularly in national, statewide and regional public forums designed to inform payers and providers on policy changes to government payor programs.
• Advocates for administrative flexibility within government regulations in order to improve efficiency and obtain proper coverage for services.
• Supports/coordinates all system Fiscal Intermediary data requests, audits and exit conferences.
• Develops and maintains appropriate relationships with the Fiscal Intermediary.
• Prepares analysis and provides recommendations to ensure that all regulatory reviews are completed accurately and on time.
• Develops and provides coordination for the system-wide monthly closing process with respect to Medicare/Medicaid liabilities.
• Maintains accurate payment for Medicare/Medicaid and monitors interim payments to determine accuracy, appropriateness and potential liability.
• Requests adjustments from United Government Services (UGS) and updates internal systems.
• Ensures proper Medicare and Medicaid reimbursement for Graduate Medical Education programs and minimizes governmental audit exposure through compliance with regulations specific to medical education programs.
• Assists with the development of pro forma analysis for new potential community partnerships (i.e., FQHC partnerships, dental residency, etc.) to project future budgets, as well as identify state and federal reimbursement to support these new care delivery models.

Requirements

Licenses, registrations, and certifications required: None.

Qualifications

Education: Bachelor's Degree in Finance or related field.

Experience

Typically requires 5 years of experience in reimbursement that includes experiences in preparation of Medicare/Medicaid cost reports, regulations and the analysis, modeling and reporting of third party payers.

Skills & Abilities

• Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting.
• Knowledge and understanding of third party regulations and the interrelationship of financial statements to not only comply with regulations but to maximize and develop strategies to increase the organization's reimbursement rate with ongoing changes.
• Demonstrates strong initiative and produces high quality analytical results.
• Able to perform tasks independently.
• Strong accounting background with experience in preparing and/or reviewing health care financial statements which are required to perform accurate account analysis.
• Strong proficiency in the use of the Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools or similar products.
• Demonstrated ability to work and function in a complex environment.
• Excellent written and verbal communication skills and the ability to communicate revenue cycle issues to all levels of the organization.
• Demonstrated ability to take initiative, produce high quality results, and perform assigned activities in an independent manner.
• Self-motivated and capable of carrying a project through 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 will be exposed to weather and road conditions.

Benefits and More

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.