Senior 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. Provides support to the Reimbursement Senior Manager to ensure accuracy and maximization of government payer reimbursement.

Responsibilities

• Prepare accurate and timely Medicare and Medicaid Cost Reports, Medicaid DSH surveys and other agency surveys on an annual basis.
• Prepare various reimbursement analyses, reviews, rate calculations, and provide support for various government audits.
• Verify and analyze interim rate calculations and final settlements by third party payers for accuracy.
• Investigate changes in reimbursement and communicate potential impacts to reimbursement by staying current on government and regulatory changes.
• Coordinate and compile Medicare, Medicaid and other third-parties annual cost reports, including development, implementation, and maintenance of time studies, statistics, and revenue and expense information.
• Provide independent peer review of cost reports, identifying discrepancies, recommending corrections, and ensuring audit readiness.
• Coordinate audits of Cost Reports or other information as required by Medicare and other payers.
• Analyze impact of audit adjustments and confirm audit issues are consistent with Medicare/Medicaid regulations.
• Coordinate updates to Cost Report software; ensure accuracy of information and incorporation of updates.
• Identify Medicare, Medicaid or other reimbursement issues that should be appealed; recommend appropriate outside resources; monitor appeals or exception requests for timely filing and resolution.
• Review rate calculations for accuracy and maximization of revenue; prepare appeals as necessary.
• Complete Critical Access Hospital (CAH) and Rural Health Clinic (RHC) monthly templates and recommend appropriate journal entries.
• Evaluate financial impact of regulatory changes on reimbursement.
• Complete ongoing evaluations of hospital and clinic designations to optimize reimbursement under current regulations.
• Prepare the Tricare/Champus reimbursement requests for capital and education costs and ad hoc reporting as needed.
• Develop and maintain appropriate documentation for interns and resident tracking, wage index and occupational mix reporting to the Medicare program.
• Reconcile all reimbursement settlement accounts and review interim rates and pass through payments monthly.
• Assist with the completion of attestations for provider-based clinics or rural health clinic designations.
• Partner with revenue cycle, finance, and operational teams to improve financial performance.
• Assist System Manager in development of policies, procedures, reports, and other tools to improve work product.
• Uphold Essentia Health’s mission, vision, values and ethical standards.

Qualifications

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

Skills

• Hands-on experience compiling Medicare and/or Medicaid cost reports.
• Understanding of CMS rules and government reimbursement requirements.
• Experience in a hospital, health system, Medicare Administrative Contractor, or healthcare reimbursement consulting environment.
• Familiarity with areas such as CAH, RHC, PPS, DSH, IME/GME, wage index, provider-based clinics, or cost settlements.
• Strong analytical reasoning, critical thinking, judgement and problem solving skills.
• Ability to manage multiple deadlines and stay organized during busy reporting seasons.
• Clear and comfortable communication with finance, revenue cycle, operations, auditors, and leadership.

Benefits

• Medical, dental, vision, life, and disability insurance.
• Supplemental benefit options.
• 401(k) plan with employer contributions.
• Professional development support including training, tuition reimbursement, and educational programs.
• Flexible scheduling and generous time off.
• Wellness resources focused on physical, mental, and emotional health.

Pay

$84,364.80 – $126,547.20

Schedule

Fully remote role; functions in Central Standard Time (CST). Day rotation with no weekends, holidays, or call obligation.