Sr. Reimbursement Analyst

Jefferson Health Plans•Philadelphia, PA

2d•Onsite

About The Position

The Senior Reimbursement Analyst independently performs complex government reimbursement reporting and analysis for assigned hospitals and entities. The position prepares and reviews Medicare and Medicaid cost-report schedules and regulatory submissions, develops reimbursement estimates and financial-impact analyses, supports audits, appeals, and settlement activities, and interprets regulatory requirements to develop well-supported recommendations for department leadership. The Senior Reimbursement Analyst leads assigned projects and process improvements, maintains strong documentation and internal controls, collaborates with internal and external stakeholders, and provides technical guidance to support accurate, timely, and compliant reimbursement results.

Requirements

Bachelor’s degree in accounting, finance, health administration, or a related field.
4 years of hospital reimbursement, healthcare finance, accounting, financial analysis, or related experience.
Experience preparing financial analyses, reconciliations, workpapers, or regulatory reports.
Experience working with spreadsheets and financial or reporting systems to collect, organize, validate, and analyze data.
Working knowledge of accounting, financial analysis, and reimbursement principles; familiarity with Medicare and Medicaid cost reporting and payment methodologies.
Ability to collect, organize, validate, reconcile, and analyze financial, statistical, and operational data with a high degree of accuracy.
Ability to research regulations and guidance, summarize relevant information, apply established procedures, and seek direction on complex or unfamiliar matters.
Knowledge of workpaper preparation, documentation standards, internal controls, audit support, and regulatory reporting requirements.
Strong analytical and problem-solving skills, including the ability to identify data inconsistencies, investigate variances, and communicate findings.
Ability to organize assignments, manage competing priorities, meet deadlines, follow through on open items, and appropriately escalate issues.
Effective written and verbal communication skills, with the ability to explain analyses, ask clarifying questions, and work productively with internal and external stakeholders.
Proficiency in spreadsheet applications, financial reporting platforms, and data-analysis tools used to prepare calculations, reconciliations, and reports.
Strong attention to detail, organization, judgment, and commitment to maintaining complete and accurate documentation.
Ability to collaborate effectively with finance, accounting, revenue cycle, legal, compliance, operations, clinical departments, auditors, consultants, and other partners.

Responsibilities

Prepare and review complex Medicare and Medicaid cost-report schedules, reimbursement workpapers, and government submissions for assigned hospitals and entities, ensuring accuracy, complete supporting documentation, and compliance with established deadlines and requirements.
Independently collect, validate, reconcile, and analyze financial, statistical, and operational data from multiple systems and departmental sources; identify inconsistencies and resolve or escalate issues as appropriate.
Develop reimbursement estimates, forecasts, reconciliations, variance analyses, and financial-impact models; interpret results and present findings and recommendations to department leadership.
Support cost-report audits, reopenings, appeals, and settlement activities by preparing and reviewing responses, workpapers, data requests, and supporting analyses and by coordinating assigned issues through resolution.
Research and interpret Medicare and Medicaid regulations, payment rules, and regulatory guidance; assess financial and operational implications and develop well-supported summaries and recommendations.
Perform detailed analyses related to disproportionate share hospital payments, indirect and direct graduate medical education, wage index, geographic reclassification, supplemental payments, and other government reimbursement methodologies.
Manage assigned components of federal and state reimbursement programs, including data collection, validation, submission preparation, reconciliation, compliance monitoring, financial tracking, and communication of results.
Prepare and review reimbursement assumptions and analyses for the annual operating budget, financial forecasts, long-range planning, period-end close, and other financial reporting activities; investigate variances and recommend adjustments.
Maintain and enhance reimbursement workpapers, process documentation, reporting standards, and internal controls; identify opportunities to improve accuracy, efficiency, and consistency.
Lead assigned reimbursement projects and process-improvement initiatives by defining work plans, coordinating information across departments, monitoring milestones, resolving issues, and communicating progress and results.
Collaborate with finance, accounting, revenue cycle, legal, compliance, operations, clinical departments, auditors, consultants, and governmental representatives; provide technical guidance and review support to team members and stakeholders on assigned areas of expertise.