SR REIMBURSEMENT ANALYST

Premier Health • Dayton, OH

7h • Remote

About The Position

This is a 100% remote work-from-home position for a Sr. Reimbursement Analyst specializing in Medicare and Medicaid Cost Reports. The role involves collecting and analyzing data, preparing documentation for various cost reports (Worksheet S-10, DSH eligibility, Bad Debt, Wage Index), calculating accounts receivable and third-party reserves, preparing Medicaid pending conversion calculations, and contributing to 340B submissions and Medicare gain/loss analysis. The analyst will also assist with the annual net revenue budget, three-year forecasting, and E&Y audit workpapers. Key responsibilities include reviewing CMS/MAC rate reviews, preparing amended cost reports, analyzing settlements, developing reimbursement factors and calculators, and preparing compliance reports for specific units. The role also requires preparing Medicare occupational mix surveys, HCAP logs, Myers & Stauffer logs for DSH audits, and submissions for Kentucky Workers’ Compensation and Montgomery County Indigent Ill Levy. Additionally, the analyst will act as a liaison for regulatory data revisions, analyze the reimbursement impact of regulatory changes, ensure compliance with laws, and maintain current knowledge of Medicare, Medicaid, and other regulations, assisting with education on Federal rules.

Requirements

• Bachelor's Degree in Business Administration majoring in Accounting, Finance or related business field required.
• 3-5 years of job-related experience required.
• Hospital reimbursement required, including Medicare and Medicaid cost report experience required.
• Current working knowledge of the financial statement process, running ad-hoc patient financial system and/or general ledger financial reports, and strong financial skills required.

Nice To Haves

• Experience in Medicare medical education reimbursement (IME/DGME)
• Experience in Medicare provider enrollment system (PECOS)

Responsibilities

• Collects, analyzes all underlying data and prepares supporting documentation for the Medicare cost report Worksheet S-10. Reviews outside consultant logs and schedules. Reviews audit adjustments for accuracy.
• Collects, analyzes all underlying data and prepares supporting documentation for the Medicare cost report Medicaid DSH eligibility. Prepares additional provider research files and reviews outside consultant logs.
• Collects, analyzes all underlying data and prepares supporting documentation for the Medicare cost reports Traditional Medicare Bad Debt and Dual Eligible logs.
• Collects, analyzes all underlying data and prepares supporting documentation for the Medicare cost report Wage Index. Reviews audit adjustments for accuracy.
• Prepares the calculation of accounts receivable and third-party reserves including the timely submission of the monthly journal entry along with additional analyses as needed.
• Collects and analyzes all underlying data and prepares the Medicaid pending conversion calculations.
• Prepares 340 B trial balances for inclusion with the annual HRSA submissions.
• Prepares Medicare gain/loss analysis for Schedule H of Form 990.
• Assists in the annual net revenue budget and three-year forecasting process. Research and completion of all governmental modeling is the primary focus.
• Assists with the preparation of E&Y audit workpapers.
• Reviews CMS/MAC rate reviews and audit adjustments for accuracy.
• Prepares amended Medicare and Medicaid cost reports and Tricare capital and direct medical education reports and supporting schedules as needed.
• Reviews tentative cost report settlements and final cost report settlements including audit adjustments for accuracy.
• Prepares Medicare and Medicaid reimbursement factors and reimbursement calculators for Inpatient, Outpatient, Psych, and Rehab.
• Collects and analyzes all underlying data in conjunction with the Rehab Unit and prepares the submission for the Inpatient Rehab Unit 75% compliance report for exemption from the Inpatient Prospective Payment System.
• Collects and analyzes all underlying data, prepares all supporting documentation, and submits in a timely and accurate manner the Medicare occupational mix surveys. Reviews audit adjustments for accuracy.
• Prepares HCAP logs and obtains supporting documentation for independent consultant review. Also, prepares the matching data in the formats used for the Medicaid cost report.
• Prepares Myers & Stauffer logs for the federal DSH audits that match the Medicaid cost report in the required format in a timely and accurate manner.
• Submits documentation for the Kentucky Workers’ Compensation Hospital Fee Schedule cost-to-charge ratio calculation.
• Collects all underlying data, prepares detail and summary invoices, and payment reconciliations for the Montgomery County Indigent Ill Levy submissions.
• Acts as a liaison between Reimbursement and the report writing team to assist in regulatory data revisions.
• Prepares detailed analysis of regulatory changes to determine the reimbursement impact to PHP.
• Ensures compliance with Federal and State laws when using PHP provider numbers, including Provider Based Status rules.
• Maintains current working knowledge of Medicare, Medicaid, and other regulations. Assists in providing education with Federal rules and regulations.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior