Reimbursement Analyst

Overview

This role supports system-wide revenue analysis and reimbursement-related financial reporting for programs, projects, and services. Responsibilities include assisting with external financial audits, Medicare and Medicaid cost report preparation, budgeting support, accounts receivable valuation analysis, and coordination of monthly closing and reimbursement monitoring.

Responsibilities

• Assist with plans and prepare revenue analysis for system-wide programs, projects, and services; monitor revenue budgets and benchmarking activities.
• Support system-wide intermediary data requests, audits, and exit conferences.
• Assist in preparing information required for system-wide external financial audits and Medicare/Medicaid interim and year-end cost reports.
• Coordinate year-end system financial audit activities with external auditors and reimbursement staff.
• Develop and maintain relationships with the fiscal intermediary and external auditors.
• Prepare analyses and provide recommendations to ensure regulatory reviews are completed accurately and on time.
• Participate in system-wide budgeting for Gross and Net Patient Revenue to ensure accuracy, timeliness, and compliance with accounting standards.
• Analyze and review the monthly accounts receivable valuation and provide recommendations to support optimal reimbursement; understand and oversee the tools used for calculation.
• Develop and coordinate the system-wide monthly closing process related to Medicare/Medicaid liabilities and allowances on patient receivables.
• Monitor processes to ensure accurate Medicare/Medicaid payments; review interim payments for accuracy, appropriateness, and potential liability.
• Request adjustments from United Government Services (UGS) and update internal systems.
• Apply knowledge of Medicare and Medicaid regulations related to current and proposed reimbursement; work with Government Affairs and external consultants to provide needed expertise.
• Coordinate with Financial Planning to prepare system budgets related to third-party reimbursement.
• Provide support to Financial Planning for retrospective financial review and pro forma development.

Requirements

• Bachelor’s Degree in Finance or related field.
• Typically requires 3 years of experience in reimbursement, including experience preparing Medicare/Medicaid cost reports, regulations, and the analysis, modeling, and reporting of third-party payers.

Knowledge, Skills & Abilities

• Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting.
• Knowledge of third-party regulations and the interrelationship of financial statements to both comply with regulations and develop strategies to increase reimbursement rate with ongoing changes.
• Strong initiative; ability to produce high-quality analytical results independently.
• Strong accounting background, including experience preparing and/or reviewing health care financial statements to support accurate account analysis.
• Proficiency with Microsoft Office (Excel, PowerPoint, Word, Access), software systems, and data management tools.
• Proficiency in data mining and analysis.
• Ability to work effectively in a complex environment; excellent written and verbal communication skills, including the ability to communicate revenue cycle issues to all levels of the organization.
• Self-motivated and capable of carrying a project through to successful completion.

Preferred Qualifications

• Advanced Excel skills
• Accounting skills
• Healthcare experience
• PowerBI experience
• Analytic tools in Epic; Slicer/Dicer and/or Reporting Workbench
• Accounts receivable experience
• Ledger entry experience

Licensure / Registration / Certification

• None required.

Physical Requirements and Working Conditions

• Must be able to sit the majority of the workday.
• Must be able to lift up to 10 lbs. occasionally.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.
• This position requires travel, with exposure to weather and road conditions.

Additional Information

• This job description reflects the general nature and level of work expected. Other related duties may be required.