Senior Medicaid & Medicare Reimbursement Consultant
About The Position
This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. This position will be responsible for ensuring the appropriate governmental (Medicare and Medicaid) reimbursement is received for OhioHealth. This position is primarily responsible for the proactive calculations and modeling of new regulatory changes and impacts as well as variance analysis of third-party liability accounts. Provides supporting work papers and documentation for third-party inquires. This position has supervisory oversight of the Reimbursement Analyst daily work schedule including flow of information, teaching of reimbursement fundamentals and principals, review of work and setting daily priorities. This positon supports the Director of Revenue and Reimbursement and Manager of Reimbursement with many special analysis throughout the year associated with revenue cycle, charge analysis, regulatory and financial reporting. The Senior Reimbursement Consultant will be a subject matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical Education, and Governmental Logs, (HCAP, UPL and Franchise Fee programs in the state of Ohio) as well as special projects as assigned. Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement and remaining up to date with all regulatory requirements, both federal and state is required. The Reimbursement Consultant position leads, advises and consults various reimbursement financial projects, as well as special projects throughout the year and needs to be able to delegate direct reports assigned to the project or process while staying connected to both the pertinent details as well as the high level strategic purpose. The Senior Reimbursement Consultant is required to use extensive interpersonal skills in communicating with all management levels at OhioHealth. This role functions in a heavily matrixed environment and requires strong prioritization, communication and planning skills.
Requirements
- Bachelor's Degree in Finance (Required)
- Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement.
- Remaining up-to-date with all federal and state regulatory requirements.
- Proficiency in Microsoft applications.
- Knowledge of clinical & financial patient management systems.
- Demonstrated ability in financial analysis and cost reporting.
- Extensive interpersonal skills in communicating with all management levels at OhioHealth.
- Strong prioritization, communication, and planning skills.
- Subject matter expert on CMS cost reporting, disproportionate share (DSH), Uncompensated Care, Bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855’s, 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 psych, inpatient rehabilitation units, Home Health and Hospice.
- Experience with CGS audits and auditors.
- Experience working with legal vendors for Medicare Appeals.
- Experience working with OHA and CBSA facilities on wage index opportunities.
Responsibilities
- Preparing and reviewing Medicare and Medicaid cost reports for all OhioHealth entities.
- Ensuring appropriate governmental (Medicare and Medicaid) reimbursement is received for OhioHealth.
- Proactive calculations and modeling of new regulatory changes and impacts.
- Variance analysis of third-party liability accounts.
- Providing supporting work papers and documentation for third-party inquiries.
- Supervisory oversight of the Reimbursement Analyst daily work schedule, including flow of information, teaching of reimbursement fundamentals and principles, review of work, and setting daily priorities.
- Supporting the Director of Revenue and Reimbursement and Manager of Reimbursement with special analyses related to revenue cycle, charge analysis, regulatory, and financial reporting.
- Acting as a subject matter expert in S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical Education, and Governmental Logs (HCAP, UPL and Franchise Fee programs in the state of Ohio), as well as special projects.
- Leading, advising, and consulting on various reimbursement financial projects and special projects.
- Delegating direct reports assigned to projects or processes while staying connected to pertinent details and high-level strategic purpose.
- Using extensive interpersonal skills in communicating with all management levels at OhioHealth.
- Consulting and oversight of key areas at OhioHealth in central and non-central Ohio facilities in reimbursement functions.
- Providing updates to the Director of Revenue and Reimbursement and Manager of Reimbursement.
- Working with legal vendors for Medicare Appeals.
- Working with OHA and CBSA facilities on wage index opportunities.
- Performing special projects/analysis as assigned by the Director of Revenue and Reimbursement and Manager of Reimbursement.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
