Reimbursement Specialist

2 weeks ago

Charlottesville, Virginia, United States Commonwealth of Virginia Full time
Job Summary

We are seeking a highly skilled Reimbursement Specialist to join our team at the Commonwealth of Virginia. The successful candidate will be responsible for performing a variety of tasks related to contractual allowances reimbursement, cost reporting, and revenue budgeting.

Key Responsibilities
  • Determine transactions related to third-party reimbursement, including contractual adjustments, settlements, and Medicare and Medicaid Cost Reports.
  • Maintain competency in reimbursement by staying up-to-date with current developments at the State and Federal level and through continuing education.
  • Perform or assist with profitability studies, rate optimization, and strategic pricing, revenue volume, and cost projections.
  • Participate in the design and planning of hospital budgets related to rate setting and contractual adjustments.
  • Implement appropriate reporting mechanisms in conjunction with the Director of Reimbursement.
  • Ensure optimal reimbursement rates and codes are implemented and communicated to departments.
  • Work with Patient Accounting staff to determine and resolve potential patient claim underpayments identified by PCON software.
  • Evaluate participating provider agreements and produce financial models for proposed agreements.
  • Meet all departmental specific competencies.
  • Adhere to medical center policies addressing infection control, safety, and personnel guidelines.
  • Demonstrate knowledge of and compliance with the hospital code of conduct and applicable corporate policies and procedures.
  • Maintain patient confidentiality and treat patients and their families with respect and dignity.
Requirements
  • Bachelor's Degree in Business, Finance, or related field.
  • 3 years' experience in Finance.
  • Certified Public Accountant (CPA) or Fellow of the Healthcare Financial Management Association (FHFMA) preferred.

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