Senior Financial Government Reimbursement Analyst

Overview

This role serves as a senior technical subject matter expert responsible for the independent preparation, coordination, and optimization of Medicare, Medicaid, Tricare, and other governmental cost reports and regulatory filings across the health system. The position involves end-to-end cost report production for assigned entities, including data collection, workpaper development, settlement modeling, and filing coordination, while interpreting and applying CMS and State Medicaid regulations to ensure compliant and optimized reimbursement outcomes.

Responsibilities

• Prepare Medicare, Medicaid, and Tricare cost reports for assigned entities, managing the full cycle from data collection and workpaper development through filing coordination.
• Interpret and apply CMS and State Medicaid regulations to ensure compliant reporting and identify reimbursement optimization opportunities.
• Support Wage Index and Occupational Mix survey preparation and filing.
• Lead preparation and analysis of complex settlement components including Medicare bad debt, DSH, S-10 uncompensated care, IME/GME, organ acquisition, ESRD, transplant, and other pass-through or supplemental payment programs.
• Validate pass-through payments and lump sum adjustments; reconcile interim rates against settled amounts.
• Coordinate supporting documentation and audit trails required for desk reviews, audits, and appeals.
• Monitor MAC correspondence, settlement notices, and regulatory communications; coordinate responses and required documentation.
• Support audit strategy development and defend filed positions through the appeals process.
• Prepare monthly third-party settlement model supporting month-end close and reserve reporting.
• Support reimbursement forecasting and reserve development through settlement outcome modeling and interim rate change analysis.
• Partner with Decision Support, General Accounting, Patient Financial Services, Case Management, and GME to validate data integrity and ensure accurate reimbursement reporting.
• Identify and resolve data discrepancies impacting cost report accuracy or settlement outcomes.
• Perform additional duties as assigned.

Requirements

Education

• Bachelor's degree in Accounting, Finance, or Business.

Experience

• Minimum 5 years of experience in accounting/finance with at least 3 years in reimbursement or cost reporting.

Knowledge, Skills, and Abilities

• Working knowledge of hospital patient accounting, general ledger, and decision support systems (such as Epic, Strata, or equivalent).
• Knowledge of pass-through payment structures, lump sum adjustments, and interim rate reconciliation.
• Experience interfacing with MACs, CMS, and state agencies during audits, desk reviews, and appeals.
• Ability to communicate complex reimbursement concepts clearly to finance, clinical, and operational stakeholders.
• Comfortable managing multiple filing deadlines and regulatory timelines simultaneously.

Preferred Qualifications

Education

• Master's degree in Finance or Accounting.

Experience

• Minimum 7 years of experience with at least 5 years in reimbursement or cost reporting.
• Experience with Organ Acquisition, 340B, and IRIS preferred.

Physical Requirements

• Ability to lift and carry up to 25 lbs occasionally (0-33% of the workday).
• Frequent sitting, occasional to frequent standing and walking.
• Close eye work including computer use, typing, reading, and writing.

Environmental Factors

• Exposure to blood-borne pathogens, bio-hazardous waste, chemicals, gases, fumes, vapors, communicable diseases, electrical shock, varying floor surfaces, temperature extremes, indoor/outdoor conditions, latex, lighting, patient care/handling injuries, radiation, shift work, and travel may be required.
• Use of personal protective equipment, including respirators, may be necessary depending on assigned work area and tasks.

Work Type and Travel

• Remote position.
• Travel may be required less than 10% of the time.

Compensation and Benefits

• Comprehensive health benefits starting on day one.
• Student loan repayment assistance and reimbursement programs.
• Family-focused benefits.
• Wellness incentives.
• Ongoing mentorship, development, and leadership programs.

Equal Opportunity Statement

The employer is an equal opportunity organization and provides consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or other characteristics protected by law. Reasonable accommodations are available upon request for qualified individuals with disabilities.