Senior Medicaid & Medicare Reimbursement Consultant

About the role

This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. The Senior Reimbursement Consultant will ensure appropriate governmental (Medicare and Medicaid) reimbursement is received for OhioHealth. Primary responsibilities include proactive calculations and modeling of new regulatory changes and impacts, variance analysis of third-party liability accounts, and providing supporting work papers and documentation for third-party inquiries.

Responsibilities

• Consulting and oversight of key reimbursement functions at OhioHealth facilities, including central and non-central Ohio locations
• Subject matter expertise in CMS cost reporting, disproportionate share (DSH), uncompensated care, bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855’s, Ohio Medicaid, HCAP, UPL and Franchise Fee programs
• Knowledge of reimbursement in specialty areas such as psych, inpatient rehabilitation units, Home Health and Hospice
• Supervisory oversight of the Reimbursement Analyst, including daily work schedule, teaching reimbursement fundamentals, reviewing work, and setting priorities
• Supporting the Director of Revenue and Reimbursement and Manager of Reimbursement with special analyses related to revenue cycle, charge analysis, regulatory and financial reporting
• Leading, advising, and consulting on reimbursement financial projects and special assignments
• Delegating tasks to direct reports while maintaining connection to both detailed and high-level strategic objectives
• Using extensive interpersonal skills to communicate with all management levels at OhioHealth
• Functioning in a heavily matrixed environment with strong prioritization, communication, and planning skills
• Working with CGS audits and auditors
• Collaborating with legal vendors for Medicare Appeals
• Working with OHA and CBSA facilities on wage index opportunities
• Completing special projects and analyses as assigned by leadership

Requirements

• Bachelor's Degree in Finance (required)
• Proficiency in Microsoft applications
• Knowledge of clinical and financial patient management systems
• Demonstrated ability in financial analysis and cost reporting