Reimbursement Specialist III

Hackensack Meridian Health•Edison, NJ

13d

About The Position

The Reimbursement Analyst III position provides specialized, senior-level technical and analytical support for all aspects within the reimbursement department for the Hackensack Meridian Health (HMH) Network. Work assignments are complex and require in-depth knowledge of governmental reimbursement, possessing strong analytical and investigative skills. This position will guide and coordinate direction on reimbursement matters, including preparation of advanced sections of the Medicare and NJDOH cost reports, completion of advanced reimbursement studies and models (PPS Rate calculations, IME/GME, APC Rate calculations, etc.), and audit coordination. In addition, coordinates strategic modeling, appeal development and tracking. Will also coordinate the completion of cost reports for a dedicated region.

Requirements

Bachelor's degree in Accounting/Finance or related field.
Minimum of 5 or more years of progressive reimbursement related experience in consulting and/or in a large health network and/or academic medical center.
Advanced proficiency in using technology including but not limited to Microsoft Office (Excel, Outlook, etc.).
Proven record of progressive professional growth and responsibility.
Excellent written and verbal communication skills.
Excellent analytical skills including ability to complete detailed work papers for an audit trail.
Effective written and verbal communication skills.
Ability to establish effective working relationships with all levels of the Hackensack Meridian Health organization as needed.

Nice To Haves

Certified Public Accountant (CPA) and/or Masters of Business Administration (MBA).
Governmental Audit experience.

Responsibilities

Keeps fully informed of current and anticipated changes in Medicare and Medicaid hospital and professional reimbursement determining the impact on the Network`s entities.
Summarizes final regulations with applicable financial impacts and distributes them to key internal stakeholders across the Network.
Prepares written comments on proposed regulatory changes and submits them to CMS and Medicaid ensuring that the Network`s voice is heard by regulators.
Organizes and coordinates potential revenue enhancement opportunities to optimize reimbursement including but not limited to: (1) combining provider numbers; Medicare wage index; disproportionate share; charity care subsidy; medical education; organ transplantation; and Medicare Bad Debts.
Researches potential governmental appeals to file. Files and tracks appeals filed.
Supports the coordination and filing of the Corporate Cost Report.
Preparation of the Medicare, Chapter 160 and Champus cost reports for hospitals including advanced worksheets.
Coordination and accumulation of information needed for the Home Health Agency and Home Office cost reports as needed.
Coordination and accumulation of statistical data as needed.
Coordination and accumulation, as needed, of Interns & Residents schedules and all required personal data including preparation of the IRIS.
Coordination and support of the Wage Index submission to CMS including acting as the point person for the Wage Index audits.
Completion of the NJ DSH and Occupational Mix Surveys.
Coordinating any bad debt audits by effectively working with Patient Accounting.
Support various Medicare and Medicaid appeals including gathering of required supporting documentation and insuring timely submissions.
Research, coordination and completion of various CMS and Molina applications such as 855s and IME/GME Resident Cap Increase applications.
Assist with assuring Medicare and Medicaid rates are correctly reported in the system.
Completion of Psychiatry PPS Exclusion analysis.
Research as needed via Internet, relevant publications, reimbursement manuals, etc. to ensure compliance and maximize reimbursement strategies within regulations.
Coordinate and support Medicare and Medicaid audits, including acting as the point person.
Review of audit adjustments including effective communication with outside auditors in resolving any issues as needed.
Software input of the cost report data as needed.
Monthly review of third party accounts of HMH hospitals.
Special projects and other duties as assigned by Management.
Adheres to HMH Organizational competencies and standards of behavior.