Sr Reimbursement Analyst

Trinity Health

11d•Hybrid

About The Position

Posting Job Description ESSENTIAL FUNCTIONS Knows, understands, incorporates and demonstrates the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions. Conducts prospective analysis of the potential financial impact on the member organizations of major changes in Medicare and Medicaid policies. Assists in related advocacy efforts regarding such regulatory changes. Monitors policies and procedures to ensure reimbursement practices adhere to federal, state and other third-party reimbursement regulations. Prepares Annual Medicare, Medicaid, Blue Cross and Tricare cost reporting for the Trinity Health Corporate Office and Trinity Information Systems. Prepares quarterly Medicaid reporting schedules. Prepares Rolling Forecasts and Annual Budgets. Participates in the Medicare, Medicaid and Blue Cross audits of Trinity Health Corporate Office, Trinity Information Systems, and the various insurance programs with focus on Graduate Medical Education, Disproportionate Share, Bad Debt and the S-10. Analyzes tentative and final settlements. Coordinates, researches and analyzes prior year reopening and appeals. Prepares financial month end close reporting for Net Revenue. Responsibilities include, but are not limited to, accessing databases, and utilizing reporting tools to extract data, generate reports, perform data analysis, and draft system/process improvement recommendations. Prepares analyses and interprets highly complex reimbursement issues. Prepares complex financial models and analyses to assure proper reimbursement. Participates in third-party payer preparing impact analysis and recommendations. Participates in developing and monitoring appeals with third party payers. Provides analytical reimbursement support, consulting, and education to the corporate office and member organizations. Reviews and analyzes member organization third party reserves and net revenue/contractual calculations. Conducts analysis related to revenue improvement initiatives. Prepares project analysis regarding operational issues, new programs, service lines, expansions, etc. Serves as a subject matter expert and resource by providing guidance and problem resolution to internal associates on matters impacting projects and day-to-day assignments. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior. Performs other duties as assigned.

Requirements

Bachelor’s degree in Business Administration, Finance, Accounting, Informatics or related field or an equivalent combination of education and related experience.
Five (5) to seven (7) years of progressively responsible operational or consulting experience in revenue management (e.g., reimbursement, cost reporting, forecasting, decision support, health information management).
Some knowledge and experience of the healthcare industry or hospital financial operations.
Advanced proficiency with Microsoft product suite (MS Word, Excel, Power Point), financial systems/software, relational database management and business intelligence reporting tools.
Ability to utilize PC-based financial tools (i.e., spreadsheets, databases, graphics, etc.).
Must possess a high degree of analytical, quantitative, evaluative and problem-solving skills.
Considerable knowledge and experience supporting and developing reporting and analytics for research, process improvement support and specific revenue management function.
Ability to develop appropriate methods to collect, analyze and report data.
Strong attention to detail and organizational skills.
Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments.
Ability to work independently and with minimal supervision.
Ability to work in a team environment providing support to multiple positions.
Ability to resolve problems and complete assignments accurately and promptly.
Excellent oral and written communication skills.
Flexibility to work with a multitude of customers and issues and willingness to take on new responsibilities.
Ability to manage/lead small projects or portions of projects.
Demonstrated ability to respect confidential and sensitive information, understanding and honoring lines of accountability and communication is essential.
Some knowledge of organization policies, procedures, and processes.
Ability to operate in an ambiguous and matrix organizational structure.
Ability to operate in a highly autonomous self-directed manner under frequently changing structures, requirements, and priorities.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, Integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Responsibilities

Conducts prospective analysis of the potential financial impact on the member organizations of major changes in Medicare and Medicaid policies.
Assists in related advocacy efforts regarding such regulatory changes.
Monitors policies and procedures to ensure reimbursement practices adhere to federal, state and other third-party reimbursement regulations.
Prepares Annual Medicare, Medicaid, Blue Cross and Tricare cost reporting for the Trinity Health Corporate Office and Trinity Information Systems.
Prepares quarterly Medicaid reporting schedules.
Prepares Rolling Forecasts and Annual Budgets.
Participates in the Medicare, Medicaid and Blue Cross audits of Trinity Health Corporate Office, Trinity Information Systems, and the various insurance programs with focus on Graduate Medical Education, Disproportionate Share, Bad Debt and the S-10.
Analyzes tentative and final settlements.
Coordinates, researches and analyzes prior year reopening and appeals.
Prepares financial month end close reporting for Net Revenue.
Responsibilities include, but are not limited to, accessing databases, and utilizing reporting tools to extract data, generate reports, perform data analysis, and draft system/process improvement recommendations.
Prepares analyses and interprets highly complex reimbursement issues.
Prepares complex financial models and analyses to assure proper reimbursement.
Participates in third-party payer preparing impact analysis and recommendations.
Participates in developing and monitoring appeals with third party payers.
Provides analytical reimbursement support, consulting, and education to the corporate office and member organizations.
Reviews and analyzes member organization third party reserves and net revenue/contractual calculations.
Conducts analysis related to revenue improvement initiatives.
Prepares project analysis regarding operational issues, new programs, service lines, expansions, etc.
Serves as a subject matter expert and resource by providing guidance and problem resolution to internal associates on matters impacting projects and day-to-day assignments.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Performs other duties as assigned.