Reimbursement Specialist III

Hackensack Meridian Health•Neptune Township, NJ

About The Position

The Reimbursement Analyst III provides specialized, senior-level technical and analytical support for reimbursement activities across the Hackensack Meridian Health Network. The work is complex and requires in-depth knowledge of governmental reimbursement, strong analytical and investigative skills, and the ability to guide and coordinate reimbursement matters. The role includes preparing advanced sections of Medicare and New Jersey Department of Health cost reports, completing advanced reimbursement studies and models such as PPS rate calculations, IME/GME, and APC rate calculations, coordinating audits, strategic modeling and appeals, and coordinating cost report completion for a dedicated region.

Requirements

Bachelor's degree in Accounting, Finance, or a related field.
At least 5 years of progressive reimbursement-related experience in consulting, a large health network, and/or an academic medical center.
Advanced proficiency with technology, including Microsoft Office applications such as Excel and Outlook.
Proven record of progressive professional growth and responsibility.
Excellent written and verbal communication skills.
Excellent analytical skills, including the ability to complete detailed work papers for an audit trail.
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 Master of Business Administration (MBA).
Governmental audit experience.

Responsibilities

Keep informed of current and anticipated Medicare and Medicaid hospital and professional reimbursement changes and determine their impact on Network entities.
Summarize final regulations and applicable financial impacts for key internal stakeholders across the Network.
Prepare written comments on proposed regulatory changes and submit them to CMS and Medicaid.
Organize and coordinate potential revenue enhancement opportunities, including provider-number combinations, Medicare wage index, disproportionate share, charity care subsidy, medical education, organ transplantation, and Medicare bad debts.
Research potential governmental appeals; file and track appeals.
Support coordination and filing of the Corporate Cost Report.
Prepare Medicare, Chapter 160, and Champus hospital cost reports, including advanced worksheets.
Coordinate and accumulate information for Home Health Agency and Home Office cost reports as needed.
Coordinate and accumulate statistical data as needed.
Coordinate and accumulate Interns & Residents schedules and required personal data, including preparation of the IRIS.
Coordinate and support the Wage Index submission to CMS, including serving as point person for Wage Index audits.
Complete NJ DSH and Occupational Mix Surveys.
Coordinate bad debt audits in collaboration with Patient Accounting.
Support Medicare and Medicaid appeals by gathering supporting documentation and ensuring timely submissions.
Research, coordinate, and complete CMS and Molina applications, such as 855s and IME/GME Resident Cap Increase applications.
Help ensure Medicare and Medicaid rates are correctly reported in the system.
Complete Psychiatry PPS Exclusion analysis.
Research relevant materials to ensure compliance and maximize reimbursement strategies within regulations.
Coordinate and support Medicare and Medicaid audits, including serving as point person.
Review audit adjustments and communicate with outside auditors to resolve issues as needed.
Enter cost report data into software as needed.
Review third-party accounts of HMH hospitals monthly.
Complete special projects and other duties assigned by Management.
Adhere to HMH Organizational competencies and standards of behavior.