Reimbursement Specialist

University of Virginia

15h

About The Position

The Reimbursement Specialist is responsible for performing functions related to contractual allowances, reimbursement, cost reporting, revenue budgeting, and special projects. This role involves implementing changes based on research of laws and regulations from Medicare, Medicaid, and other third-party payers. Key duties include preparing monthly analyses for contractual adjustments and bad debts, managing cost report settlements, preparing annual cost reports, and serving as the primary contact for intermediary audits, reviews, and appeals. The specialist will also implement rate optimization analyses and changes, and work closely with the Director of Reimbursement on budget and cost issues.

Requirements

Bachelor’s Degree in Business Finance or related field is required.
3 years’ experience in Finance required.

Nice To Haves

Certified Public Accountant Fellow HFMA (FHFMA) preferred.
Experience utilizing Siemen's preferred.

Responsibilities

Determines transactions related to third-party reimbursement including contractual adjustments settlements receivable (payable) Medicare and Medicaid Cost Reports appeals amendments and re-openings.
Maintains competency in reimbursement by keeping knowledge of current developments at the State and Federal level and through continuing education.
Performs or assists with profitability studies rate optimization and strategic pricing revenue volume and cost projections financial feasibility studies trend analysis and other decision support projects and reports.
Participates in design and planning of Hospital budget relating to rate setting and contractual adjustments.
Implements appropriate reporting mechanisms in conjunction with Director of Reimbursement.
Ensures reimbursement optimal rates and codes are implemented and communicated to the departments and helps the charge master analysts in the establishment of all hospital services rates.
Works in conjunction with Patient Accounting staff to determine and resolve potential patient claim underpayments identified by PCON software.
Evaluates participating provider agreements and produces financial models for proposed agreements.
Meets all departmental specific competencies.
Adheres to medical center policies addressing infection control safety and personnel guidelines.
Demonstrates knowledge of and compliance with the hospital code of conduct and applicable corporate policies and procedures.
Maintains patient confidentiality and treats patients and their families with respect and dignity.