Senior Reimbursement Analyst

Children's National Hospital; Silver Spring (MD); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare institution is seeking a Senior Reimbursement Analyst to prepare and file Medicare and Medicaid cost reports, manage audit support, and analyze financial data. Candidates should have a Bachelor's degree and at least three years of relevant experience, along with strong knowledge of reimbursement regulations. This role demands strong analytical and interpersonal skills in a collaborative environment to support the financial integrity of the organization.

Qualifications

• Minimum of three (3) years relevant experience in the healthcare industry.
• Experience in Medicare/Medicaid Cost Report preparation and review is required.

Responsibilities

• Prepare and file Medicare and Medicaid cost reports and audit support.
• Compile and analyze data relevant to reimbursement functions.
• Work with internal and external auditors.

Skills

Strong knowledge of Medicare and Medicaid reimbursement regulations

Analytical skills

Attention to detail

Communication skills

Interpersonal skills

Microsoft Office (Excel, Access, Word, Power Point)

Education

Bachelor's Degree in Business, healthcare or related field

Job description

Under direction of the Reimbursement Manager, The Senior Reimbursement Analyst will be responsible for preparing and filing the annual Medicare and Medicaid cost reports, audit support, third party settlement analysis, CHGME reporting, and other month end financial reporting assignments. Responsibilities also include compilation and analysis of data relevant to various reimbursement departments functions.

Minimum Education
Bachelor's Degree Business, health care or related field (Required)

Minimum Work Experience

Minimum of three (3) years relevant experience in the healthcare industry

Required Skills/Knowledge
Strong knowledge of Medicare and Medicaid reimbursement regulations for hospitals and/or physician payment mechanisms; net patient revenue valuation is a plus.
Experience in Medicare/Medicaid Cost Report preparation and review.
Knowledge of how to research CMS regulations.
Must demonstrate strong analytical skills and attention to detail.
Excellent communication and interpersonal skills.
Strong in Microsoft office products, primarily Excel, Access, Word and Power Point.

Functional Accountabilities
Cost Reporting and Audit Function

• Prepare assigned detailed schedules, working documents and other applicable data for Revenues and Expenses for the applicable cost reports.

• Compile annual Hospital statistics for inclusion in cost report to include Square Feet, Meals Served, Pounds of Laundry etc.

• Work with internal and external auditors; respond to the annual Medicare cost report desk review and CHGME review.

• Assist in the preparation of all appeals (Medicare/Medicaid Cost Reports and others) as directed by the Reimbursement Manager.

• Support data mining and analytics of all annual cost reports.

Reimbursement Functions

• Work collaboratively with internal departments and external agencies to gather and disseminate data as necessary.
• Assess the reasonableness of hospital interim reimbursement rates and special payments and address as appropriate.
• Maintain a basic working knowledge of changes in Medicare/Medicaid statutes, regulations, principles of reimbursement, policy publications and published appeal decisions.

• Manage and document correspondence with government agencies, payors and other applicable parties.

• Assist with the annual reconciliation of Medicaid HMO GME payments.

Reimbursement Report/Analysis

• Disseminate, track, report progress and summarize Physician Time Studies on a quarterly basis for inclusion in the hospital cost report.

• Prepare the annual SHPDA report and various financial surveys.

• Monthly analysis of third party general ledger settlement accounts.

• Assist with analysis for annual Medicaid and payor rebasing.

• Support all other current and future functions of the reimbursement department as assigned.

Organizational Accountabilities
Organizational Commitment/Identification

• Partner in the mission and upholds the core principles of the organization

• Committed to diversity and recognizes value of cultural ethnic differences

• Demonstrate personal and professional integrity

• Maintain confidentiality at all times

Teamwork/Communication

• Demonstrate collaborative and respectful behavior

• Partner with all team members to achieve goals

• Receptive to others’ ideas and opinions

Performance Improvement/Problem-solving

• Contribute to a positive work environment

• Demonstrate flexibility and willingness to change

• Identify opportunities to improve clinical and administrative processes

• Make appropriate decisions, using sound judgment