Reimbursement Analyst - Senior

Key Responsibilities

• Provide and maintain Hospital reimbursement expertise as it relates to Medicare, Blue Cross and Medicaid.
• Studies and comprehends reimbursement regulations and attends reimbursement seminars to maintain knowledge of reimbursement regulations and current issues.
• Trains and educates accounting department and other hospital employees in the technical aspects of reimbursement.
• Relates reimbursement knowledge to Hospital operations and makes recommendations on how to maximize reimbursement.
• Identifies appealable items which could enhance reimbursement.
• Prepares and submits appeals.
• Accurately prepares and submits on a timely basis the annual institutional cost report, physician questionnaire and other third party information requests in compliance with applicable instructions.
• Captures and responds to all audit inquiries and investigates all audit findings.
• Makes recommendations as to whether the third party audit findings are in compliance with reimbursement regulations.
• Accurately calculate and record hospital inpatient and outpatient revenues on a monthly basis.
• Accurately calculate net patient service revenue (inpatient and outpatient) on a monthly basis for inclusion in the monthly financial statements within 1% of total revenue.
• Maintains revenue files on computer system which enable calculation of revenue per DRG.
• Ensures rates used in issuing patient bills are the most recent certified and approved rates by regulatory agencies.
• Performs other duties as assigned.

Minimum Qualifications

• Bachelor's degree in Accounting or Business, with prior reimbursement experience or an equivalent combination of education and work experience.
• 3 to 5 years of prior reimbursement experience with demonstrated progressive levels of responsibility.
• Strong analytical, computer, and communication skills.