Senior Government Reimbursement Analyst

About the role

The Senior Government Reimbursement Analyst is responsible for the accuracy, reporting and compliance of over $1 billion of government payer reimbursement. This position provides support to the Reimbursement Senior Manager to ensure accuracy and maximization of government payer reimbursement. Key responsibilities include preparing accurate and timely Medicare and Medicaid Cost Reports, Medicaid DSH surveys and other agency surveys on an annual basis, preparing various reimbursement analyses, supporting government audits, verifying and analyzing interim rate calculations, investigating changes in reimbursement, and communicating potential impacts to reimbursement.

Responsibilities

• Coordinates and compiles Medicare, Medicaid and other third-party annual cost reports, including development, implementation, and maintenance of time studies, statistics, and revenue and expense information for entities within the Essentia Health System.
• Provides independent peer review of cost reports, identifying discrepancies, recommending corrections, and ensuring audit readiness.
• Analyzes impact of audit adjustments and confirms audit issues are consistent with Medicare/Medicaid regulations.
• Captures updates to Cost Report software; ensures accuracy of information, incorporates updates, and identifies Medicare, Medicaid or other reimbursement issues that should be appealed.
• Reviews rate calculations for accuracy and maximization of revenue. Prepares appeals as necessary.
• Completes Critical Access Hospital (CAH) and Rural Health Clinic (RHC) monthly templates and recommends appropriate journal entries.
• Evaluates financial impact of regulatory changes on reimbursement.
• Develops and maintains appropriate documentation for interns and resident tracking, wage index, and occupational mix reporting to the Medicare program.
• Reconciles all reimbursement settlement accounts and reviews interim rates and pass-through payments monthly.
• Assists with the completion of attestations for provider-based clinics or rural health clinic designations.
• Partners with revenue cycle, finance, and operational teams to improve financial performance.
• Aids in the development of policies, procedures, reports, and other tools to improve work product.
• Performs Essentia-wide duties as requested by the designated Essentia leader.

Requirements

• Requires a Bachelor’s Degree in Accounting, Finance or related field.
• Minimum 5 years work experience in the healthcare field.
• Knowledge of Medicare and Medicaid reimbursement regulations and reporting requirements.
• Experience with various Medicare Cost Reports required.
• Experience working with Excel and electronic cost reporting software required.

Essential Functions and Accountabilities

• Coordinates and compiles Medicare, Medicaid and other third-party annual cost reports, as required by current regulations, including the development, implementation, and maintenance of time studies, statistics (both utilization and cost allocation), and revenue and expense information for entities within the Essentia Health System.
• Provide independent peer review of cost reports, identifying discrepancies, recommending corrections, and ensuring audit readiness.
• Analyzes impact of audit adjustments and confirms audit issues are consistent with Medicare/Medicaid regulations.
• Captures updates to Cost Report software; ensures accuracy of information, incorporates updates, and identifies Medicare, Medicaid or other reimbursement issues that should be appealed.
• Reviews rate calculations for accuracy and maximization of revenue. Prepares appeals as necessary.
• Completes Critical Access Hospital (CAH) and Rural Health Clinic (RHC) monthly templates and recommends appropriate journal entries.
• Evaluates financial impact of regulatory changes on reimbursement.
• Develops and maintains appropriate documentation for interns and resident tracking, wage index, and occupational mix reporting to the Medicare program.
• Reconciles all reimbursement settlement accounts and reviews interim rates and pass-through payments monthly.
• Assists with the completion of attestations for provider-based clinics or rural health clinic designations.
• Partners with revenue cycle, finance, and operational teams to improve financial performance.
• Aids in the development of policies, procedures, reports, and other tools to improve work product.
• Performs Essentia-wide duties as requested by the designated Essentia leader.