Healthcare Reimbursement Senior Consultant

Overview

This role is part of a healthcare consulting practice focused on Medicare and Medicaid reimbursement. The position involves working directly with hospitals, health systems, and other healthcare providers on Medicare and Medicaid cost reporting, reimbursement analysis, and related advisory engagements.

Responsibilities

• Prepare and review Medicare and Medicaid cost reports for hospitals and other healthcare providers, including analysis of financial, statistical, reimbursement, and operational data supporting cost report filings.
• Apply knowledge of Medicare and Medicaid reimbursement regulations, CMS requirements, and state-specific reimbursement methodologies.
• Analyze cost report data and reimbursement results to identify trends, inconsistencies, potential reimbursement opportunities, compliance considerations, and areas requiring further investigation.
• Perform detailed reconciliations of cost report data to financial statements, general ledger information, patient statistics, and other supporting documentation.
• Independently manage significant portions of client engagements, including gathering client information, performing analyses, documenting conclusions, and meeting filing and project deadlines.
• Prepare and review specialized Medicare and Medicaid reimbursement analyses and projects, including:
  • Wage index and occupational mix reviews
  • IME/GME reimbursement
  • Provider-based services
  • Special hospital designations such as Sole Community Hospital and Medicare-Dependent Hospital status
• Assist clients with Medicare Administrative Contractor (MAC), state Medicaid agency, and other regulatory requests related to cost reports and reimbursement matters, as applicable to the engagement.
• Develop clear workpapers, analyses, client deliverables, and documentation supporting reimbursement positions and conclusions.
• Communicate directly with client finance, reimbursement, and accounting personnel to obtain information, resolve questions, and communicate project status and findings.
• Identify potential reimbursement opportunities and risks and communicate observations and recommendations to engagement leadership and clients.
• Manage multiple concurrent client engagements and priorities while meeting regulatory filing dates and internal deadlines.
• Collaborate with senior leaders on complex reimbursement matters and special consulting projects.
• Provide day-to-day guidance, technical support, and review assistance to Consultants and other junior team members.
• Contribute to continuous improvement of cost reporting processes, analytical tools, templates, and engagement methodologies.
• Stay current on changes in CMS regulations, Medicare reimbursement policy, Medicaid reimbursement requirements, and healthcare industry developments; share relevant knowledge with colleagues and clients.
• Maintain high standards of quality, professionalism, confidentiality, and client service while meeting the firm’s engagement and productivity expectations.

Requirements

• Bachelor’s degree in accounting, finance, healthcare administration, business, or a related field.
• Minimum 3+ years of relevant healthcare reimbursement, Medicare/Medicaid cost reporting, healthcare finance, or related consulting experience.
• Hands-on experience preparing and/or reviewing Medicare hospital cost reports.
• Experience preparing and/or reviewing Medicaid or state medical assistance cost reports.
• Working knowledge of federal and state healthcare reimbursement regulations and reimbursement methodologies.
• Strong understanding of hospital financial statements, general ledger data, reimbursement statistics, and the relationship between financial information and regulatory cost reporting.
• Demonstrated ability to analyze healthcare reimbursement and cost report data and develop meaningful observations and recommendations.
• Strong Microsoft Excel skills and proficiency with Microsoft Office; experience with Medicare/Medicaid cost reporting or healthcare reimbursement software is preferred.
• Strong analytical, problem-solving, organizational, and project-management skills.
• Ability to independently manage assigned workstreams and deliver high-quality work in a deadline-driven, multi-client environment.
• Strong written and verbal communication skills, including the ability to communicate technical reimbursement concepts clearly to clients and colleagues.
• Demonstrated ability to develop effective client relationships and collaborate across engagement teams.
• Ability and willingness to coach and support junior team members.
• Ability to quickly learn new regulations, reimbursement methodologies, technology platforms, and processes.
• Commitment to continuous professional development and sharing knowledge across the practice.

Preferred Qualifications

• Experience with hospital Medicare cost reporting, including CMS Form 2552-10.
• Experience with reimbursement projects involving wage index, occupational mix, IME/GME, provider-based departments, or special hospital classifications.
• Experience interacting with MACs, state Medicaid agencies, or other healthcare reimbursement authorities.
• Experience within a healthcare consulting, public accounting, hospital reimbursement, or health system finance environment.
• Advanced Excel and healthcare data-analysis capabilities.

Compensation & Benefits

• Pay range: $78,500 to $126,400.
• Actual compensation depends on factors including skills, experience, qualifications, professional certifications, work arrangements, geographic location, and other business and organizational needs.

Location

Work location status varies by opportunity. Please discuss the work location status with your talent acquisition professional to understand the requirements for the opportunity you are exploring.