INTRODUCTION

Performs system wide analysis, modeling, reporting, and reviewing of proper reimbursement from third party payers in accordance with regulatory, accounting, and contractual standards and arrangements to include monthly accounts receivable valuation, cost report preparation, and revenue cycle analysis. Collaborates with the Manager of Reimbursement to coordinate information required for the preparation of the Medicare and Medicaid cost reports, and any related reimbursement issues for the monthly closing process, year-end audit and annual budget.

ROLE AND RESPONSIBILITIES:

• Assist with plans and prepares revenue analysis for system wide programs, projects and services, and monitors revenue budgets and benchmarking activities. Acts as support for all system intermediary data requests, audits and exit conferences.
• Assists in preparation and provides necessary information required for the completion of system wide external financial audits and working with teams for Medicare and Medicaid interim and year-end cost reports.
• Assists with coordination of the year-end system financial audit with external auditors and reimbursement staff.
• Develops and maintains appropriate relationships with the Fiscal Intermediary and external auditors.
• Prepares analysis and assists in making recommendations to ensure that all regulatory reviews are completed accurately and on time.
• Participates in the development and preparation of the system wide budgeting for Gross and Net Patient Revenue to ensure accuracy, timeliness, and compliance with accounting standards.
• Analyzes and reviews the monthly accounts receivable valuation and provides recommendations to ensure optimal reimbursement. Understands and oversees the tools used for calculation.
• Develops and provides coordination for the system wide monthly closing process with respect to Medicare/Medicaid liabilities and the allowances on patient receivables.
• Monitors processes to ensure accurate payment for Medicare/Medicaid and monitors interim payments to determine accuracy, appropriateness and potential liability. Requests adjustments from United Government Services (UGS) and updates internal systems.
• Develops and applies an understanding of Medicare and Medicaid regulations pertaining to current and proposed reimbursement and works directly with Government Affairs and external consultants to provide needed expertise.
• Coordinates, with the Financial Planning department(s), the preparation of System budgets as they pertain to third party reimbursement. Provides support to Financial Planning in the development of retrospective financial review and pro forma development.

LICENSURE, REGISTRATION, AND/OR CERTIFICATION REQUIRED:

• None Required.

EDUCATION REQUIRED:

• Bachelor's Degree in Finance or related field.

EXPERIENCE REQUIRED:

• Typically requires 3 years of experience in reimbursement that includes experiences in preparation of Medicare/Medicaid cost reports, regulations and the analysis, modeling and reporting of third party payers.

KNOWLEDGE, SKILLS & ABILITIES REQUIRED:

• Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting.
• Knowledge and understanding of third-party regulations and the interrelationship of financial statements to not only comply with regulations but to maximize and develop strategies to increase the organization's reimbursement rate with ongoing changes.
• Demonstrates strong initiative and produces high quality analytical results. Able to perform tasks independently.
• Strong accounting background with experience in preparing and/or reviewing health care financial statements which are required to perform accurate account analysis.
• Strong proficiency in the use of the Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools or similar products.
• Proficiency in data mining and analysis.
• Demonstrated ability to work and function in a complex environment. Excellent written and verbal communication skills and the ability to communicate revenue cycle issues to all levels of the organization.
• Demonstrated ability to take initiative, produce high quality results, and perform assigned activities in an independent manner. Self-motivated and capable of carrying a project through to successful completion.

PREFERRED:

• Advance Excel function knowledge
• Experience in Workday, Epic, Strata or OfficeConnect
• Experience working in a fully remote setting

PHYSICAL REQUIREMENTS AND WORKING CONDITIONS:

• Must be able to sit the majority of the workday.
• Must be able to lift up to 10 lbs. occasionally.
• Operates all equipment necessary to perform the job.
• Exposed to normal office environment.

LI-remote

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.