Senior Medicaid & Medicare Reimbursement Consultant

Overview

This role is responsible for preparing and reviewing Medicare and Medicaid cost reports for all organizational entities.

Responsibilities

• Ensure appropriate governmental (Medicare and Medicaid) reimbursement is received.
• Perform proactive calculations and modeling of new regulatory changes and impacts, including variance analysis of third-party liability accounts.
• Prepare supporting work papers and documentation for third-party inquiries.
• Provide supervisory oversight of the Reimbursement Analyst daily workflow, including:
  • Managing the daily schedule and flow of information
  • Teaching reimbursement fundamentals and principles
  • Reviewing work and setting daily priorities
• Support the Director of Revenue and Reimbursement and the Manager of Reimbursement with special analyses throughout the year related to:
  • Revenue cycle
  • Charge analysis
  • Regulatory and financial reporting
• Serve as a subject matter expert in areas including:
  • S-10
  • Wage Index
  • Bad Debts
  • Medicare Audits
  • Disproportionate Share
  • Indirect Medical Education
  • Graduate Medical Education
  • Governmental Logs, including HCAP, UPL and Franchise Fee programs in the state of Ohio
• Lead, advise, and consult on reimbursement financial projects and other special projects throughout the year, including delegating work to direct reports while maintaining both key details and the project’s strategic purpose.
• Communicate effectively with management at all levels in a heavily matrixed environment.

Required Knowledge / Subject Matter Expertise

• CMS cost reporting, disproportionate share (DSH), uncompensated care, bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting
• Tricare and 855’s
• Ohio Medicaid, HCAP, UPL and Franchise Fee programs
• Facility types: Acute Care Hospitals, Critical Access Hospitals, Sole Community Hospitals, and Rural Health Clinics
• Reimbursement in specialty areas including psych, inpatient rehabilitation units, Home Health and Hospice
• Knowledge of projects as assigned by the Director of Revenue and Reimbursement and the Manager of Reimbursement

Additional Duties (as assigned)

• Provide updates to the Director of Revenue and Reimbursement and the Manager of Reimbursement
• Support CGS audits and auditors
• Work with the legal vendor for Medicare Appeals
• Work with OHA and CBSA facilities on wage index opportunities
• Perform special projects and analysis as assigned

Minimum Qualifications

• Bachelor’s Degree in Finance (Required)

Additional Qualifications

• Proficiency in Microsoft applications
• Knowledge of clinical & financial patient management systems
• Demonstrated ability in financial analysis and cost reporting

Compensation & Benefits

• Not specified in the provided job description.

Location

• Remote work is not indicated. Remote positions, if marked, are only eligible for work from Ohio.

Work Schedule

• Work Shift: Day
• Scheduled Weekly Hours: 40

Equal Employment Opportunity

The organization is an equal opportunity employer and supports compliance with state, federal, and local regulations, including non-discrimination in hiring, employment, and advancement.