Senior Reimbursement Analyst

Beth Israel Lahey Health; Boston (MA); On-site; USD 83,000 - 112,000; Full time

Job summary

Beth Israel Lahey Health is seeking a Senior Reimbursement Reporting Analyst to support Third-Party reimbursement and Net Revenue analysis. You will work with the Director and finance colleagues to manage cost reporting, audits, and annual settlements.

Responsibilities include maintaining AR models, interfacing with CMS/CHIA, and producing reports for management and auditors. Strong Excel skills and healthcare finance experience are required.

Qualifications

• Bachelor's degree in finance, accounting, healthcare administration, or related field.
• 3–5 years of experience in healthcare finance and Medicare cost reporting.
• Exposure to healthcare reimbursement concepts (Medicare, Medicaid, DRGs, APCs).
• Advanced proficiency in Microsoft Excel (pivot tables, formulas, data analysis).
• Experience with healthcare revenue related functions, such as net revenue, government reimbursement, revenue cycle.

Responsibilities

• Keep abreast of CMS/State regulations impacting BILH reporting.
• Develop and present to Manager the financial impact of annual Medicare rule changes.
• Develop and maintain AR financial models; create journal entries by business unit.
• Compile Net Revenue components to assist management reviews.
• Analyze monthly case mix and explain changes vs. budget and prior months.
• Assist in annual Medicare and CHIA Cost Reports submission.
• Accumulate and report Medicare Physician Time Allocation.
• Develop quarterly Third-Party reserve rates by payer and update models.
• Maintain Medicare Bad Debt and Crossover logs.
• Create and audit monthly Observation log for Medicare.
• Assist in transplant data reporting to Medicare and related modeling for interim vs final payments.
• Provide analysis for auditors on AR contractual and third-party reserves.
• Submit monthly HSN surcharge report; assist in AWI audits.
• Assist in Resident rotation schedules and payroll-related filings.
• Collaborate with PFS Team on cash reconciliations and GL mapping.

Skills

Advanced Excel

Analytical thinking

Attention to detail

Effective communication

Education

Bachelor's degree in finance, accounting, healthcare administration, or related field

Tools

HFS

Epic

Strata

Axiom

Job description

When you join the growing BILH team, you're not just taking a job, you're making a difference in people’s lives.

The Senior Reimbursement Reporting Analyst, reporting to the Director, Cost Reporting & Reimbursement, participates in a wide variety of tasks in support of the institution's Third-Party reimbursement efforts and valuation of the Third-Party Accounts Receivable. Responsible for the full range of reimbursement functions: cost reporting, audit, interim rate and settlement calculation, net revenue preparation and analysis, net revenue budget preparation and various special projects. Assist in the management of projects and work closely with all members of the Reimbursement work team, including the Director, other Sr. Financial Analysts and Financial Analysts, as well as other Finance personnel.

Job Description

Keep abreast of Center for Medicare and Medicaid Services and State Regulations where changes and updates may have an impact on the BILH reporting and compiling of required information.

Develop and present to Manager the estimated financial impact of the annual changes in Medicare rules and regulations associated with reimbursement related issues, such as DSH, IME, GME, EHR and Bad Debts in addition to any Quality Measures Reporting (Value Based Purchasing & Readmission Adjustments and Medicare Cost Reporting changes.

Develop and maintain monthly Hospital and Professional Accounts Receivable (AR) financial models; creating the monthly Third-Party contractual allowance and reserve for bad debt general ledger journal entries by business unit and reconcile entries to the general ledger to review with Manager.

Compile components of Net Revenue in order to assist management in the review of monthly, annual and budgeted Net Revenue for specific Business Units.

Analyze and report monthly case mix information to management with explanations for significant changes versus budget and month to month comparisons.

Assist in the annual preparation and submission of the Medicare and Center for Health Information and Analysis (CHIA) Cost Reports ensuring expense, revenue and statistical information is accurate and subsequent audits.

Responsible for the accumulation and reporting of the Medicare Physician Time Allocation, along with assisting in the development and presentation of educational programs offered to each department.

Develop, update, explain and maintain quarterly Third-Party contractual reserve rates by payer; implementing these rates into the Hospital and Professional AR financial models to estimate and report the net value of AR.

Maintain Medicare Bad Debt and Crossover logs for Medicare Reimbursement.

Create and audit monthly Observation log for Medicare Reimbursement.

Assist in all aspects of gathering and reporting transplant related information to Medicare and develop financial modeling to measure the reimbursement impact of interim Medicare payments versus final settlements.

Provide summary and detailed financial analysis in support of AR contractual and Third-Party reserves to auditors.

Submit monthly HSN surcharge report to the state. Assist in the Area Wage Index (AWI) audit, creating documentation related to Salaries & Wages, Contract Labor, Pension and other Wage Related Costs. Create IME reports for submission and invoice verification.

Assist in maintaining Resident and Fellow rotation schedules and demographic information for filing with Medicare.

Work closely with PFS Team on matters that effect reimbursement, including Cash reconciliations, Credit Balance reviews and mapping AR transactions to the GL.

Attends meetings as required and participate on various committees as requested.

Minimum Qualifications

• Bachelor's degree in finance, Accounting, Healthcare Administration, or related field
• Three to five years of experience in healthcare Finance and Medicare cost reporting
• Exposure to healthcare reimbursement concepts (Medicare, Medicaid, DRGs, APCs)
• Advanced proficiency in Microsoft Excel (pivot tables, formulas, data analysis)
• Experience with healthcare revenue related functions, such as net revenue, government reimbursement, revenue cycle

Preferred Qualifications & Skills

• Familiarity with cost report software (e.g., HFS)
• Experience with healthcare financial systems (e.g., Epic, Strata, Axiom)
• Basic understanding of net revenue modeling and reserve methodologies
• Attention to detail with ability to manage large datasets
• Strong communication skills with ability to translate data into insights
• Ability to manage multiple priorities in a deadline-driven environment
• Must be able to handle multiple, complex tasks and priorities.
• Must have strong analytical skills.
• Must be a dedicated team player with the willingness and desire to learn and grow within the organization

Pay Range

$83,200.00 USD - $111,904.00 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled