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Senior Reimbursement Analyst

2 months ago

Dayton, United States Premier Health Partners Full time

**This can be a 100% remote position**



The Senior Reimbursement Analyst will be responsible for assisting in the annual contractual budget and forecasting processes, preparing the Medicare and Medicaid cost report, and is responsible for the completion of the monthly contractual allowances. The Senior Reimbursement Analyst will work with internal and external auditors in validating information as reported on financial statements and third-party cost reports. The analyst should have a thorough knowledge of federal and state rules and regulations.



Essential Duties & Functions:


  • Collects and analyzes all underlying data, prepares all supporting workpaper documentation, and submits in a timely manner all governmental cost report schedules along with the submission of the Medicare cost reports, Medicaid cost reports, and Tricare capital and direct medical education reports. Requires strong knowledge of IME and DGME reimbursement related to the Medicare cost report. Follows governmental regulations when preparing these reports.
  • Collects, analyzes all underlying data and prepares supporting documentation for:

The Medicare cost report Worksheet S-10. Reviews outside consultant logs and schedules. Reviews audit for accuracy.

the Medicare cost adjustments report Medicaid DSH eligibility. Prepares additional provider research files and reviews outside consultant logs.

the Medicare cost reports Traditional Medicare Bad Debt and Dual Eligible logs.

the Medicare cost report Wage Index. Reviews audit adjustments for accuracy.


  • Prepares the calculation of accounts receivable and third-party reserves including the timely submission of the monthly journal entry along with additional analyses as needed.
  • Collects and analyzes all underlying data and prepares the Medicaid pending conversion calculations.
  • Prepares 340 B trial balances for inclusion with the annual HRSA submissions.
  • Prepares Medicare gain/loss analysis for Schedule H of Form 990.
  • Assists in the annual net revenue budget and three-year forecasting process. Research and completion of all governmental modeling is the primary focus.
  • Assists with the preparation of E&Y audit workpapers.
  • Reviews CMS/MAC rate reviews and audit adjustments for accuracy.
  • Prepares amended Medicare and Medicaid cost reports and Tricare capital and direct medical education reports and supporting schedules as needed.
  • Reviews tentative cost report settlements and final cost report settlements including audit adjustments for accuracy.
  • Prepares Medicare and Medicaid reimbursement factors and reimbursement calculators for Inpatient, Outpatient, Psych, and Rehab.
  • Collects and analyzes all underlying data in conjunction with the Rehab Unit and prepares the submission for the Inpatient Rehab Unit 75% compliance report for exemption from the Inpatient Prospective Payment System.
  • Collects and analyzes all underlying data, prepares all supporting documentation, and submits in a timely and accurate manner the Medicare occupational mix surveys. Reviews audit adjustments for accuracy.
  • Prepares HCAP logs and obtains supporting documentation for independent consultant review. Also, prepares the matching data in the formats used for the Medicaid cost report.
  • Prepares Myers & Stauffer logs for the federal DSH audits that match the Medicaid cost report in the required format in a timely and accurate manner.
  • Submits documentation for the Kentucky Workers’ Compensation Hospital Fee Schedule cost-to-charge ratio calculation.
  • Collects all underlying data, prepares detail and summary invoices, and payment reconciliations for the Montgomery County Indigent Ill Levy submissions.
  • Acts as a liaison between Reimbursement and the report writing team to assist in regulatory data revisions.
  • Prepares detailed analysis of regulatory changes to determine the reimbursement impact to PHP.
  • Ensures compliance with Federal and State laws when using PHP provider numbers, including Provider Based Status rules.
  • Maintains current working knowledge of Medicare, Medicaid, and other regulations. Assists in providing education with Federal rules and regulations.





JOB QUALIFICATIONS

Education: Bachelor’s Degree in Accounting, Finance or related business field required.

Licensure: N/A

Certification: N/A


Minimum Level of Experience Required: 3 - 5 years of job related experience

Prior job title or occupational experience: Hospital reimbursement required, including Medicare and Medicaid cost report experience.

Prior specific functional responsibilities: Current working knowledge of the financial statement process, running ad-hoc patient financial system and/or general ledger financial reports, and strong financial skills required.

Preferred experience: Experience in Medicare medical education reimbursement (IME/DGME) and Medicare provider enrollment system (PECOS).

Skills/Other:

  • Windows, Microsoft Excel and Word experience and expertise required.
  • Strong written and verbal communication skills.
  • Strong interpersonal skills necessary to interact with all departments and levels of personnel.
  • Ability to prioritize and coordinate multiple projects simultaneously.
  • Strong attention to detail.
  • Ability to research, obtain, and evaluate information.
  • Ability to analyze data.
  • Ability to work independently and proactively.
  • Ability to work in a team environment.