Senior Medicaid & Medicare Reimbursement Consultant

OhioHealth•WORK AT HOME - OHIO, OH

About The Position

This position prepares and reviews Medicare and Medicaid cost reports for all OhioHealth entities and ensures appropriate governmental reimbursement. It proactively calculates and models regulatory changes and their impacts, conducts variance analysis of third-party liability accounts, and prepares supporting work papers and documentation for third-party inquiries. The role provides supervisory oversight of the Reimbursement Analyst’s daily work, including information flow, instruction in reimbursement fundamentals and principles, work review, and setting priorities. It supports the Director of Revenue and Reimbursement and Manager of Reimbursement with special analyses related to the revenue cycle, charge analysis, regulatory matters, and financial reporting. The Senior Reimbursement Consultant serves as a subject matter expert across Medicare and Medicaid reimbursement topics, including cost reporting, S-10, Wage Index, bad debts, Medicare audits and appeals, disproportionate share, indirect and graduate medical education, and Ohio governmental programs. The role leads, advises, and consults on reimbursement and other financial projects, delegates work to assigned direct reports, and maintains both detailed and strategic oversight. It requires extensive communication with management at all levels and strong prioritization, communication, and planning in a matrixed environment. The position covers central and non-central Ohio facilities.

Requirements

Bachelor’s degree in Finance.
Proficiency in Microsoft applications.
Knowledge of clinical and financial patient management systems.
Demonstrated ability in financial analysis and cost reporting.
Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement, including current federal and state regulatory requirements.
Knowledge of CMS cost reporting, disproportionate share (DSH), uncompensated care, bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855s, Ohio Medicaid, HCAP, UPL, and Franchise Fee programs.
Knowledge of Acute Care Hospitals, Critical Access Hospitals, Sole Community Hospitals, and Rural Health Clinics.
Knowledge of reimbursement in specialty areas such as psychiatric services, inpatient rehabilitation units, Home Health, and Hospice.
Strong interpersonal, prioritization, communication, and planning skills for work in a heavily matrixed environment.

Responsibilities

Prepare and review Medicare and Medicaid cost reports for all OhioHealth entities.
Ensure OhioHealth receives appropriate Medicare and Medicaid reimbursement.
Proactively calculate and model regulatory changes and their impacts.
Conduct variance analysis of third-party liability accounts and provide supporting work papers and documentation for third-party inquiries.
Oversee Reimbursement Analyst daily work schedules, information flow, instruction, work review, and priorities.
Support the Director of Revenue and Reimbursement and Manager of Reimbursement with special analyses involving revenue cycle, charge analysis, regulatory matters, and financial reporting.
Serve as a subject matter expert in reimbursement areas including S-10, Wage Index, bad debts, Medicare audits, disproportionate share, indirect and graduate medical education, and Ohio governmental programs.
Lead, advise, and consult on reimbursement financial projects and other assigned projects, delegating work to assigned direct reports while maintaining detailed and strategic oversight.
Communicate with management at all levels and provide updates to the Director of Revenue and Reimbursement and Manager of Reimbursement.
Consult on reimbursement functions at central Ohio and non-central Ohio facilities.
Work with CGS audits and auditors and with the legal vendor on Medicare appeals.
Work with OHA and CBSA facilities on Wage Index opportunities.
Complete special projects and analyses assigned by the Director of Revenue and Reimbursement and Manager of Reimbursement.