Government Reimbursement Specialist

4 weeks ago

Atlanta, Georgia, United States Emory HealthcareEmory University Full time
Job Summary

We are seeking a highly skilled Government Reimbursement Specialist to join our team at Emory Healthcare. This individual will be responsible for overseeing the financial reporting and analysis related to governmental reimbursements, including cost reporting and audits.

Key Responsibilities
  • Ensure accurate and timely revenue recognition and calculate estimated reimbursements for Emory Healthcare.
  • Work closely with hospital operations, clinical departments, and the finance team to support financial reporting associated with governmental reimbursements and required cost reporting compliance.
  • Prepare cost reports, monitor compliance with CMS regulations, and prepare to report on all supplemental Federal and State reimbursement matters.
  • Coordinate Medicare and Medicaid audits and assist with preparation of all supporting work papers and documentation across Emory Healthcare.
  • Conduct detailed financial analyses to monitor revenue performance, identify trends, and develop insights to improve governmental reimbursements.
  • Analyze Medicare Administrative Contractor (MAC) correspondence and interim rate setting to ensure accurate reimbursement and compliance with regulations.
  • Assist with monitoring changes in Federal and State regulations regarding hospital and physician reimbursement requirements, with priority focus on billing changes impacting physician and hospital chargemasters.
  • Assist with Provider-based attestations and all Federal and State reporting associated with them.
  • Monitor changes in Federal and State regulations affecting the healthcare industry and assist with preparation of pro-forma analysis as it relates to third-party reimbursement.
  • Review and assist with preparation of the annual State of Georgia, DCH Reports, including DSH, GME, Hospital Financial Survey (HFS) and Indigent Care Trust Fund Survey (ICTF), etc.
  • Manage graduate medical education reporting and help to provide organizational guidance to maximize reimbursements.
  • Assist with preparation and review of annual hospital UPL and physician LIP reporting and other regulatory/contractually obligated reports.
  • Prepare research, analyze, and communicate reimbursement matters.
  • Review and assist with strategic pricing analysis in association with the annual budget for charge master pricing and net revenues.
  • Develop year-end audit documentation; review and oversee detailed schedules and analysis to support financial statements. Work with external and internal auditors to interpret schedules and resolve discrepancies.
  • Develop control procedures and assist in the development of new procedures to improve internal control measures.
  • Prepare, develop, and monitor the budget and compliance with fiscal constraints related to governmental reimbursements for actual, budget, and prior period financial information.
  • Develop and review information and analysis for long-range financial and cash flow forecasting.
  • Review and analyze data trends in governmental reimbursements, work with vendors to develop analysis and support ongoing and future reimbursements.
  • Enhance and improve analysis to determine the impact of payer mix and changes to operations on governmental reimbursements.
  • Develop recommendations to management.
  • Identify and review analysis involving new business initiatives and models governmental reimbursement impacts.
  • Create recommendations on policy issues to maintain compliance with regulations and guidelines.
  • Enhance and be proactive in implementing procedures consistent with established policies.
  • Supervise and analyze current policies and procedures and assess effectiveness.
  • Oversee and manage special projects.
  • Oversee the preparation of special impact studies and other financial surveys and questionnaires.
  • Ensure professional development and attend educational in-services as appropriate.
  • Participate in professional activities and organizations to maintain knowledge of current trends, practices, and developments.
  • Review, prepare, and analyze statistical reports, financial statements, and supporting schedules for management.
  • Identify, develop, and implement methods for improving reporting efficiency. Identify requirements and develop reports required by state and federal agencies and ensure compliance.
  • Provide guidance and direction to professional staff.
  • Perform related responsibilities as required.
Requirements
  • 6 years related experience required with an MBA or CPA preferred.
  • Experience in preparation of Medicare and Medicaid cost reports required.
  • Experience with complex academic healthcare and transplants preferred.
  • Strong knowledge of Medicare and Medicaid reimbursement regulations.
  • Excellent analytical and problem-solving skills.
  • Proven leadership and team management abilities.
  • Preferred technical qualifications: Knowledge and experience with Epic, Stratajazz, PeopleSoft, SQL, Power BI, EPSI, and Kodiak (RCA).
Education
  • A bachelor's degree in accounting, finance, data or business analytics or information systems related field.
Additional Details

Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status, or any other classification protected by applicable federal, state, or local law.

Emory Healthcare will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Diversity, Equity, and Inclusion.

Emory Healthcare is committed to achieving a diverse workforce through equal opportunity and nondiscrimination policy in all aspects of employment including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.

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