Sr. Reimbursement Consultant

2 months ago

Schenectady New York, United States Orlando Health Full time
Position Summary:
Responsible for creation, execution and refinement of financial analysis, processes, accounting, and reporting for reimbursement activities for assigned hospitals.

Responsibilities:
• Responsible for accurate preparation and submission of health system Medicare and the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) cost reports and amendments, re-openings and appeals, if applicable, in accordance with State and Federal regulations.
• Provides specific expertise in the areas of Medical Education, Bad Debts, DSH, Wage Index, and S-10 reporting for the complex health system.
• Coordinates procurement/completion of time studies, rotation schedules, statistics, available bed counts, and bad debt logs throughout the fiscal year needed to complete cost reports. Provide support for any external reviews done to optimize reimbursement, such as DSH, BD, WI, and S-10.
• Coordinates any health system audits conducted by or on behalf of Medicare and/or Medicaid agencies, and challenges adverse adjustments. Communicates with the appropriate levels of governmental auditors as appropriate and review documentation to ensure appropriate reimbursement.
• Maintains knowledge of current regulations and reviews proposed changes that impact the health system's reimbursement.
Disseminate changes in reimbursement to the appropriate levels of management to fosterinformed decision-making and compliance
with laws and regulations. Assists with development of any record-keeping policies and procedures required by new/changing regulations or payment methods.
• Prepares the annual State DSH/LIP Surveys, 990 Schedule H, and other required filings and related audit defense.
• Maintains updated enrollment records and submits revalidations and provider-based attestations for new and existing facilities and services. Provides any needed support for the enrollment of any additional 340B sites. Monitors area wage index and file MGCRB reclassification requests if beneficial.
• Calculates and analyzes third-party settlement balances and reserves on a monthly/annual basis and make applicable adjustments.
Provides documentation during year-end financial audits that support third-party receivables/payables, such as detailed workpapers and MAC correspondence.
• Identifies and implements process improvement opportunities while always looking for ways to optimize reimbursement.
• Participates in project teams to provide reimbursement expertise necessary in the decision-making process. Conducts reimbursement impact analyses and prepares provider comment letters to propose regulatory changes that are submitted to CMS for consideration. Performs other projects as assigned.
• Maintains compliance with all Orlando Health policies and procedures.

Qualifications:
Education/Training
Bachelor’s degree in Accounting, Finance or Business Administration preferred but not required.

Licensure/Certification
CPA preferred but not required.

 

Experience
5-10 years of experience in preparing Medicare cost reports in a hospital system or consulting firm. Experience in coordinating audits of Medicare cost reports. Ability to use various reimbursement software and Microsoft Office applications. Database, HFS, SQL, Absolute, Lawson, and EPIC experience a plus

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