Senior Reimbursement Analyst

Minimum Education

Bachelor's Degree Business, health care or related field (Required)

Minimum Work Experience

Minimum of three (3) years relevant experience in the healthcare industry

Required Skills/Knowledge

Strong knowledge of Medicare and Medicaid reimbursement regulations for hospitals and/or physician payment mechanisms; net patient revenue valuation is a plus.

Experience in Medicare/Medicaid Cost Report preparation and review.

Knowledge of how to research CMS regulations.

Must demonstrate strong analytical skills and attention to detail.

Excellent communication and interpersonal skills.

Strong in Microsoft office products, primarily Excel, Access, Word and Power Point.

Functional Accountabilities

Cost Reporting and Audit Function

• Prepare assigned detailed schedules, working documents and other applicable data for Revenues and Expenses for the applicable cost reports.
• Compile annual Hospital statistics for inclusion in cost report to include Square Feet, Meals Served, Pounds of Laundry etc.
• Work with internal and external auditors; respond to the annual Medicare cost report desk review and CHGME review.
• Assist in the preparation of all appeals (Medicare/Medicaid Cost Reports and others) as directed by the Reimbursement Manager.
• Support data mining and analytics of all annual cost reports.
  
  

Reimbursement Functions

• Work collaboratively with internal departments and external agencies to gather and disseminate data as necessary.
• Assess the reasonableness of hospital interim reimbursement rates and special payments and address as appropriate.
• Maintain a basic working knowledge of changes in Medicare/Medicaid statutes, regulations, principles of reimbursement, policy publications and published appeal decisions.
• Manage and document correspondence with government agencies, payors and other applicable parties.
• Assist with the annual reconciliation of Medicaid HMO GME payments.
  
  

Reimbursement Report/Analysis

• Disseminate, track, report progress and summarize Physician Time Studies on a quarterly basis for inclusion in the hospital cost report.
• Prepare the annual SHPDA report and various financial surveys.
• Monthly analysis of third party general ledger settlement accounts.
• Assist with analysis for annual Medicaid and payor rebasing.
• Support all other current and future functions of the reimbursement department as assigned.
  
  

Organizational Accountabilities

Organizational Commitment/Identification

• Partner in the mission and upholds the core principles of the organization
• Committed to diversity and recognizes value of cultural ethnic differences
• Demonstrate personal and professional integrity
• Maintain confidentiality at all times
  
  

Teamwork/Communication

• Demonstrate collaborative and respectful behavior
• Partner with all team members to achieve goals
• Receptive to others’ ideas and opinions
  
  

Performance Improvement/Problem-solving

• Contribute to a positive work environment
• Demonstrate flexibility and willingness to change
• Identify opportunities to improve clinical and administrative processes
• Make appropriate decisions, using sound judgment
  
  

Under direction of the Reimbursement Manager, The Senior Reimbursement Analyst will be responsible for preparing and filing the annual Medicare and Medicaid cost reports, audit support, third party settlement analysis, CHGME reporting, and other month end financial reporting assignments. Responsibilities also include compilation and analysis of data relevant to various reimbursement departments functions.