Reimbursement Specialist III

Hackensack Meridian Health; Wall Township (NJ); On-site; USD 87,000 - 107,000; Full time

Job summary

Hackensack Meridian Health is seeking a Reimbursement Analyst III to provide senior-level technical and analytical support within the reimbursement department across the network. The role will guide Medicare/NJDOH reporting and coordinate cost reports, audits, and appeals to maximize reimbursement while maintaining compliance.

The position requires a Bachelor's degree in Accounting/Finance and at least 5 years of reimbursement experience in a health network or academic medical center.

Qualifications

• Bachelor's degree in Accounting/Finance or related field.
• Minimum of 5+ years of progressive reimbursement related experience in consulting and/or in a large health network and/or academic medical center.
• Advanced proficiency in using technology including but not limited to Microsoft Office (Excel, Outlook, etc.).
• Proven record of progressive professional growth and responsibility.
• Excellent written and verbal communication skills.
• Effective written and verbal communication skills.
• Ability to establish effective working relationships with all levels of the Hackensack Meridian Health organization as needed.

Responsibilities

• Keeps fully informed of current and anticipated changes in Medicare and Medicaid hospital and professional reimbursement determining the impact on the Network`s entities.
• Summarizes final regulations with applicable financial impacts and distributes them to key internal stakeholders across the Network.
• Prepares written comments on proposed regulatory changes and submits them to CMS and Medicaid ensuring that the Network`s voice is heard by regulators.
• Organizes and coordinates potential revenue enhancement opportunities to optimize reimbursement including but not limited to: (1) combining provider numbers; Medicare wage index; disproportionate share; charity care subsidy; medical education; organ transplantation; and Medicare Bad Debts.
• Researches potential governmental appeals to file. Files and tracks appeals filed.
• Supports the coordination and filing of the Corporate Cost Report.
• Preparation of the Medicare, Chapter 160 and Champus cost reports for hospitals including advanced worksheets.
• Coordination and accumulation of information needed for the Home Health Agency and Home Office cost reports as needed.
• Coordination and accumulation of statistical data as needed.
• Coordination and accumulation, as needed, of Interns & Residents schedules and all required personal data including preparation of the IRIS.
• Coordination and support of the Wage Index submission to CMS including acting as the point person for the Wage Index audits.
• Completion of the NJ DSH and Occupational Mix Surveys.
• Coordinating any bad debt audits by effectively working with Patient Accounting.
• Support various Medicare and Medicaid appeals including gathering of required supporting documentation and insuring timely submissions.
• Research, coordination and completion of various CMS and Molina applications such as 855s and IME/GME Resident Cap Increase applications.
• Assist with assuring Medicare and Medicaid rates are correctly reported in the system.
• Completion of Psychiatry PPS Exclusion analysis.
• Research as needed via Internet, relevant publications, reimbursement manuals, etc. to ensure compliance and maximize reimbursement strategies within regulations.
• Coordinate and support Medicare and Medicaid audits, including acting as the point person.
• Review of audit adjustments including effective communication with outside auditors in resolving any issues as needed.
• Software input of the cost report data as needed.
• Monthly review of third party accounts of HMH hospitals.
• Special projects and other duties as assigned by Management.
• Adheres to HMH Organizational competencies and standards of behavior.

Skills

Analytical skills

Communication skills

Audit coordination

Education

Bachelor's degree in Accounting/Finance

Tools

Microsoft Office (Excel)

Job description

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Reimbursement Analyst III position provides specialized, senior-level technical and analytical support for all aspects within the reimbursement department for the Hackensack Meridian Health (HMH) Network. Work assignments are complex and require in-depth knowledge of governmental reimbursement, possessing strong analytical and investigative skills. This position will guide and coordinate direction on reimbursement matters, including preparation of advanced sections of the Medicare and NJDOH cost reports, completion of advanced reimbursement studies and models (PPS Rate calculations, IME/GME, APC Rate calculations, etc.), and audit coordination. In addition, coordinates strategic modeling, appeal development and tracking. Will also coordinate the completion of cost reports for a dedicated region.

Responsibilities

A day in the life of a Reimbursement Analyst III at Hackensack Meridian Health includes:

• Keeps fully informed of current and anticipated changes in Medicare and Medicaid hospital and professional reimbursement determining the impact on the Network`s entities.
• Summarizes final regulations with applicable financial impacts and distributes them to key internal stakeholders across the Network.
• Prepares written comments on proposed regulatory changes and submits them to CMS and Medicaid ensuring that the Network`s voice is heard by regulators.
• Organizes and coordinates potential revenue enhancement opportunities to optimize reimbursement including but not limited to: (1) combining provider numbers; Medicare wage index; disproportionate share; charity care subsidy; medical education; organ transplantation; and Medicare Bad Debts.
• Researches potential governmental appeals to file. Files and tracks appeals filed.
• Supports the coordination and filing of the Corporate Cost Report.
• Preparation of the Medicare, Chapter 160 and Champus cost reports for hospitals including advanced worksheets.
• Coordination and accumulation of information needed for the Home Health Agency and Home Office cost reports as needed.
• Coordination and accumulation of statistical data as needed.
• Coordination and accumulation, as needed, of Interns & Residents schedules and all required personal data including preparation of the IRIS.
• Coordination and support of the Wage Index submission to CMS including acting as the point person for the Wage Index audits.
• Completion of the NJ DSH and Occupational Mix Surveys.
• Coordinating any bad debt audits by effectively working with Patient Accounting.
• Support various Medicare and Medicaid appeals including gathering of required supporting documentation and insuring timely submissions.
• Research, coordination and completion of various CMS and Molina applications such as 855s and IME/GME Resident Cap Increase applications.
• Assist with assuring Medicare and Medicaid rates are correctly reported in the system.
• Completion of Psychiatry PPS Exclusion analysis.
• Research as needed via Internet, relevant publications, reimbursement manuals, etc. to ensure compliance and maximize reimbursement strategies within regulations.
• Coordinate and support Medicare and Medicaid audits, including acting as the point person.
• Review of audit adjustments including effective communication with outside auditors in resolving any issues as needed.
• Software input of the cost report data as needed.
• Monthly review of third party accounts of HMH hospitals.
• Special projects and other duties as assigned by Management.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Bachelor's degree in Accounting/Finance or related field.
• Minimum of 5 or more years of progressive reimbursement related experience in consulting and/or in a large health network and/or academic medical center.
• Advanced proficiency in using technology including but not limited to Microsoft Office (Excel, Outlook, etc.).
• Proven record of progressive professional growth and responsibility.
• Excellent written and verbal communication skills.
• Excellent analytical skills including ability to complete detailed workpapers for an audit trail.
• Effective written and verbal communication skills.
• Ability to establish effective working relationships with all levels of the Hackensack Meridian Health organization as needed.

Education, Knowledge, Skills and Abilities Preferred:

• Certified Public Accountant (CPA) and/or Masters of Business Administration (MBA).
• Governmental Audit experience.

Starting Minimum Rate

Minimum rate of $97,011.20 Annually

Job Posting Disclosure

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package. The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to: Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness. Experience: Years of relevant work experience. Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training. Skills: Demonstrated proficiency in relevant skills and competencies. Geographic Location: Cost of living and market rates for the specific location. Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization. Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered. Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts. In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.