Senior Medicaid & Medicare Reimbursement Consultant

OhioHealth Corporation; Columbus (OH); On-site; USD 90,000 - 120,000; Full time

Job summary

OhioHealth in Columbus, OH seeks a Senior Reimbursement Consultant to lead Medicare/Medicaid cost reporting for multiple entities. You will oversee calculations, modeling of regulatory changes, and variance analysis of third-party liability accounts.

You will supervise daily activities, mentor staff, and collaborate with directors on revenue cycle, charge analyses, and regulatory reporting. Deep knowledge of CMS, DSH, HCAP, and GME is essential.

Qualifications

• Bachelor's degree in Finance or related field required.
• Strong financial analysis and cost reporting experience.
• Proficiency with Microsoft Office and healthcare management systems.

Responsibilities

• Prepare and review Medicare and Medicaid cost reports for all OhioHealth entities.
• Ensure appropriate governmental reimbursement is captured for OhioHealth.
• Perform variance analysis and support third-party inquiries with documentation.
• Supervise Reimbursement Analysts and mentor staff on reimbursement principles.
• Lead special projects and provide updates to senior leadership.
• Maintain knowledge of CMS/Medicare rules and state Medicaid requirements.

Skills

Financial analysis

Cost reporting

Microsoft applications

CMS cost reporting

Education

Bachelor's Degree: Finance

Tools

Microsoft Office

Clinical & financial patient management systems

Job description

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

Job Description Summary

This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.

• This position will be responsible for ensuring the appropriate governmental (Medicare and Medicaid) reimbursement is received for OhioHealth.
• This position is primarily responsible for the proactive calculations and modeling of new regulatory changes and impacts as well as variance analysis of third-party liability accounts. Provides supporting work papers and documentation for third-party inquires.
• This position has supervisory oversight of the Reimbursement Analyst daily work schedule including flow of information, teaching of reimbursement fundamentals and principals, review of work and setting daily priorities.
• This positon supports the Director of Revenue and Reimbursement and Manager of Reimbursement with many special analysis throughout the year associated with revenue cycle, charge analysis, regulatory and financial reporting.
• The Senior Reimbursement Consultant will be a subject matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical Education, and Governmental Logs, (HCAP, UPL and Franchise Fee programs in the state of Ohio) as well as special projects as assigned.
• Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement and remaining up to date with all regulatory requirements, both federal and state is required.
• The Reimbursement Consultant position leads, advises and consults various reimbursement financial projects, as well as special projects throughout the year and needs to be able to delegate direct reports assigned to the project or process while staying connected to both the pertinent details as well as the high level strategic purpose.
• The Senior Reimbursement Consultant is required to use extensive interpersonal skills in communicating with all management levels at OhioHealth.
• This role functions in a heavily matrixed environment and requires strong prioritization, communication and planning skills.

Responsibilities And Duties

Consulting and oversite of key areas at OhioHealth in the central Ohio facilities as well as non-central Ohio facilities in the reimbursement functions.

Reimbursement Functions

Knowledge in the following areas: Subject matter expert on CMS cost reporting, disproportionate share (DSH), Uncompensated Care, Bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855’s, Ohio Medicaid, HCAP, UPL and Franchise Fee programs. Knowledge of Acute Care Hospitals, Critical Access Hospitals, Sole Community Hospitals and Rural Health Clinics. Knowledge of reimbursement in specialty areas such psych, inpatient rehabilitation units, Home Health and Hospice. Projects as assigned by Director of Revenue and Reimbursement and Manager of Reimbursement. Provide Director of Revenue and Reimbursement and Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals. Working with OHA and CBSA facilities on wage index opportunities Special projects / analysis as assigned by the Director of Revenue and Reimbursement and Manager of Reimbursement.

Minimum Qualifications

Bachelor's Degree: Finance (Required)

Additional Job Description

Min: Proficiency in Microsoft applications, knowledge of clinical & financial patient management systems, demonstrated ability in financial analysis and cost reporting.

Work Shift

Day

Scheduled Weekly Hours

40

Department

Reimbursement

Join us!

• if your passion is to work in a caring environment
• if you believe that learning is a life-long process
• if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

Remote Work Disclaimer

Positions marked as remote are only eligible for work from Ohio.