Senior Reimbursement Analyst

Essentia Health•Fargo, ND

1d•Remote

About The Position

The Senior Government Reimbursement Analyst is responsible for the accuracy, reporting, and compliance of over $1 billion of government payer reimbursement. This role provides support to the Reimbursement Senior Manager to ensure accuracy and maximization of government payer reimbursement. The analyst is responsible for preparing accurate and timely Medicare and Medicaid Cost Reports, Medicaid DSH surveys, and other agency surveys on an annual basis. They will also prepare various reimbursement analyses, reviews, rate calculations, and provide support for various government audits. This role involves verifying and analyzing interim rate calculations and final settlements by third-party payers for accuracy, investigating changes in reimbursement, and communicating potential impacts by staying current on government and regulatory changes.

Requirements

Requires a Bachelor’s Degree in Accounting, Finance or related field
Requires minimum 5 years work experience in the healthcare field
Knowledge of Medicare and Medicaid reimbursement regulations and reporting requirements
Experience with various Medicare Cost Reports required
Experience working with Excel and electronic cost reporting software required
Strong analytical reasoning, critical thinking, judgement and problem solving skills in order to independently assess, interpret, and address complex issue in a continually changing environment.

Nice To Haves

Have hands-on experience compiling Medicare and/or Medicaid cost reports.
Understand CMS rules and government reimbursement requirements and enjoy applying them to real-world reimbursement work.
Have worked in a hospital, health system, Medicare Administrative Contractor, or healthcare reimbursement consulting environment.
Are familiar with areas such as CAH, RHC, PPS, DSH, IME/GME, wage index, provider-based clinics, or cost settlements.
Enjoy detailed analytical work where accuracy directly impacts reimbursement and compliance.
Can manage multiple deadlines and stay organized during busy reporting seasons.
Communicate clearly and comfortably with finance, revenue cycle, operations, auditors, and leadership.

Responsibilities

Coordinates and compiles Medicare, Medicaid, and other third-parties annual cost reports, as required by current regulations, including the development, implementation, and maintenance of time studies, statistics (both utilization and cost allocation), and revenue and expense information for entities within the Essentia Health System.
Provides independent peer review of cost reports, identifying discrepancies, recommending corrections, and ensuring audit readiness.
Coordinates audits of Cost Reports or other information as required by Medicare and other payers.
Analyzes impact of audit adjustments and confirms audit issues are consistent with Medicare/Medicaid regulations.
Coordinates updates to Cost Report software; ensures accuracy of information, ensures updates are incorporated.
Identifies Medicare, Medicaid, or other reimbursement issues that should be appealed, recommends appropriate outside resources for pursuing appeals, monitors the process to ensure that appeals or exception requests are filed in a timely manner, and follows up to ensure timely resolution.
Reviews rate calculations for accuracy and maximization of revenue.
Prepares appeals as necessary.
Completes Critical Access Hospital (CAH) and Rural Health Clinic (RHC) monthly templates and recommends appropriate journal entries.
Evaluates financial impact of regulatory changes on reimbursement.
Completes ongoing evaluations of hospital and clinic designations to optimize reimbursement under current regulations.
Responsible for preparing the Tricare/Champus reimbursement requests for capital and education costs and ad hoc reporting as needed.
Develops and maintains appropriate documentation for interns and resident tracking, wage index and occupational mix reporting to the Medicare program.
Reconciles all reimbursement settlement accounts and reviews interim rates and pass-through payments monthly.
Assists with the completion of attestations for provider-based clinics or rural health clinic designations.
Partners with revenue cycle, finance, and operational teams to improve financial performance.
Assists System Manager in development of policies, procedures, reports, and other tools to improve work product.
Performs Essentia-wide duties as requested by the designated Essentia leader.
Upholds Essentia Health’s mission, vision, values and ethical standards and demonstrate the behavioral and service expectations as defined in our policies and procedures.