Reimbursement Specialist
About The Position
To perform the functions of contractual allowances reimbursement cost reporting revenue budgeting and special projects. To implement changes resulting from research of laws and regulations issued by Medicare Medicaid and other third party payers. To prepare monthly analyses related to allowances for contractual adjustments and bad debts as well as cost report settlements receivable (payable). To prepare annual cost reports and be point of contact for intermediary audits reviews and appeals. To implement rate optimization analyses and changes. To closely interact with Director of Reimbursement on reimbursement budget and cost issues. Determines transactions related to third-party reimbursement including contractual adjustments settlements receivable (payable) Medicare and Medicaid Cost Reports appeals amendments and re-openings. Mains 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. In addition to the above job responsibilities, other duties may be assigned.
Requirements
- Bachelor’s Degree in Business Finance or related field
- 3 years’ experience in Finance
Nice To Haves
- Certified Public Accountant Fellow HFMA (FHFMA) preferred
- Experience utilizing Siemen's preferred
Responsibilities
- Perform the functions of contractual allowances reimbursement cost reporting revenue budgeting and special projects.
- Implement changes resulting from research of laws and regulations issued by Medicare Medicaid and other third party payers.
- Prepare monthly analyses related to allowances for contractual adjustments and bad debts as well as cost report settlements receivable (payable).
- Prepare annual cost reports and be point of contact for intermediary audits reviews and appeals.
- Implement rate optimization analyses and changes.
- Closely interact with Director of Reimbursement on reimbursement budget and cost issues.
- Determine transactions related to third-party reimbursement including contractual adjustments settlements receivable (payable) Medicare and Medicaid Cost Reports appeals amendments and re-openings.
- Maintain competency in reimbursement by keeping knowledge of current developments at the State and Federal level and through continuing education.
- Perform or assist 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.
- Participate in design and planning of Hospital budget relating to rate setting and contractual adjustments.
- Implement appropriate reporting mechanisms in conjunction with Director of Reimbursement.
- Ensure reimbursement optimal rates and codes are implemented and communicated to the departments and help the charge master analysts in the establishment of all hospital services rates.
- Work in conjunction with Patient Accounting staff to determine and resolve potential patient claim underpayments identified by PCON software.
- Evaluate participating provider agreements and produce financial models for proposed agreements.
- Meet all departmental specific competencies.
- Adhere to medical center policies addressing infection control safety and personnel guidelines.
- Demonstrate knowledge of and compliance with the hospital code of conduct and applicable corporate policies and procedures.
- Maintain patient confidentiality and treat patients and their families with respect and dignity.
Benefits
- Medical, Dental, and Vision Insurance
- Paid Time Off
- Long-term and Short-term Disability
- Retirement Savings
- Health Saving Plans
- Flexible Spending Accounts
- Certification and education support
- Generous Paid Time Off
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
