Senior Reimbursement Analyst
LCMC Health•Irvine, CA
•Onsite
About The Position
The Reimbursement Analyst Senior is responsible for compiling the information needed for claims submissions. Serves as a central resource for reimbursement analyses, audit and assists with the annual cost report preparation and other reporting requirements. Assists in building financial processes/models to estimate Medicare GME and other reimbursements based on current regulations and specific client circumstances. Provides and interprets reimbursement patterns and trend analyses for various departments. Provides guidance and support to junior team members as needed.
Requirements
- 8 years government healthcare reimbursement and accounting experience in a healthcare setting
- Experience and analytical skills related to case mix/reimbursement systems
- Experience and knowledge with CMS PRM regulations manuals, the CMS 2552 software system and the CMS IACS/EIDM system
- Experience with Medicare IRIS reporting system.
- Experience with electronic cost reporting software systems
- PC skills (Excel, Access Word, PowerPoint).
- Familiarity with EDP and microcomputer systems.
- Comprehensive knowledge of Medicare. Medicaid reimbursement principles relating to Home Office, Hospitals, Nursing Homes and Home Health agencies.
Responsibilities
- Assists in the preparation of accurate government regulatory reports, including year end and interim Medicare/Medicaid cost reports for submission to the intermediary, within a designated timeframe.
- Assists in preparation of Medicare, Medicaid and CHAMPUS annual cost reports.
- Computes interim Medicare/Medicaid settlements and impact on reimbursement for the hospital.
- Provides support and documentation needed by various auditors such as independent, Medicare and Medicaid.
- Assists in providing all data and/or special reports and projects for Medicare/Medicaid appeals and/or reopening.
- Stays up to date on changes to Medicare reimbursement in general and specifically federal regulations related to graduate medical education (GME) and providing education about their impact to other team members and clients.
- Analyzes financial data.
- Designs and generates reports for management's use in operational decisions regarding new and existing programs.
- Directs the preparation of reimbursement studies as needed by senior management.
- Researches regulations related to the implementation of new programs, services, and ventures, and for developing techniques for maximizing reimbursement.
- Develops techniques for effective analysis of billing and collections efforts.
- Develops, prepares & presents financial impact of all new & proposed Medicare / Medicaid regulations to Senior Management.
- Evaluates interim payments from the third-party payers for accuracy & adequate cash flow.
- Coordinates with appropriate teams for the production of reports for cost reporting/cost analyses purposes.
- Reviews generally accepted accounting principles & auditing standards as they apply to the reimbursement area.
- Assists in the development of contractual allowances for budget projections.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
