Reimbursement Analyst III

Job Description
Our client is seeking an experienced Reimbursement Analyst III for a long-term contract opportunity. This position supports reimbursement and cost reporting across the companies system, providing key analytical and accounting support for hospital cost reports, regulatory filings, and financial performance tracking. The role ensures accuracy and compliance in reporting to Medicare, Medicaid/Medi-Cal, and other regulatory agencies while supporting financial analysis for systemwide reimbursement and hospital key indicators (H&KI).

Key Responsibilities

• Systemwide Reimbursement & Cost Reporting
• Perform reimbursement and cost reporting functions across all company affiliates.
• Complete and file accurate and timely Medicare, Medicaid/Medi-Cal, and other state/federal regulatory reports and disclosures, ensuring compliance with internal policies and regulatory standards.
• Prepare well-documented workpapers to support revenues, expenses, and adjustments claimed in cost reports.
• Analyze accounting and financial data to identify non-allowable expenses and ensure proper reporting treatment.
• Support cost report audits, validate audit adjustments, and participate in the appeals process as needed.
• Financial Analysis & Compliance
• Conduct detailed financial analyses and reconciliations in Excel to support hospital cost accounting, H&KI reporting, and Medicare/Medicaid reimbursement.
• Develop multi-year projections on government payer revenues and reimbursement impacts from new legislation or regulatory changes.
• Maintain and validate contractual allowance calculations to ensure accurate third-party settlements and accounts receivable valuation.
• Ensure compliance with GAAP, Medicare/Medicaid reimbursement methodologies, and internal accounting policies.
• Cross-Functional Collaboration
• Collaborate closely with reimbursement, accounting, and finance teams across multiple facilities.
• Partner with affiliate CFOs and management to review findings, discuss audit results, and finalize report submissions.
• Support internal stakeholders (e.g., Managed Care, Budgeting, and Financial Planning) with reimbursement and cost data analysis.
• Communicate effectively with both technical and non-technical stakeholders to explain complex financial information clearly.
• Continuous Improvement & Team Contribution
• Provide feedback, training, and technical guidance on cost report preparation and regulatory changes.
• Identify and recommend process improvements for data accuracy, reporting workflows, and compliance.
• Contribute to the team's knowledge base on evolving reimbursement and audit requirements.

Required Skills & Experience

• Bachelor's degree in Accounting, Finance, Business, or Healthcare Administration (or equivalent experience).
• Minimum 5+ years of recent experience in healthcare reimbursement, cost reporting, or healthcare financial analysis.
• Strong foundation in GAAP accounting principles and healthcare regulatory reimbursement. Proficiency in advanced Excel (pivot tables, VLOOKUPs, data reconciliation, complex formulas).
• Familiarity with H&KI (Hospital Key Indicators) or similar hospital financial performance metrics.
• Excellent analytical and communication skills, with the ability to translate complex data into actionable insights.
• Working knowledge of Medicare/Medicaid reimbursement rules, audit and appeals processes, and OSHPD reporting.

Kavaliro provides Equal Employment Opportunities to all employees and applicants. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Kavaliro is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Kavaliro will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please respond to this posting to connect with a company representative.

Job Requirements

Hybrid