Sr Reimbursement Analyst

CHI; Englewood (CO); On-site; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a Senior Reimbursement Analyst to join their team. In this pivotal role, you will be responsible for preparing cost reports and ensuring compliance with Medicare and Medicaid regulations. Your expertise will help shape the future of reimbursement services while maintaining high standards of ethical conduct. This position offers an opportunity to contribute to the mission of building healthy communities and advocating for those in need. If you are passionate about healthcare reimbursement and looking to make a meaningful impact, this role is perfect for you.

Qualifications

• 5+ years of experience with Medicare and Medicaid regulations required.
• Strong knowledge of government reimbursement and audit processes.

Responsibilities

• Prepare cost reports for Medicare, Medicaid, and other agencies.
• Assist in improving internal business processes related to reimbursement.

Skills

Medicare regulations

Medicaid regulations

General accounting

Audit processes

Regulatory reimbursement

Education

Bachelor’s degree in Business Administration

Equivalent work experience

Job description

Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring, and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities

The Senior Reimbursement Analyst is responsible for providing cost report preparation, cost report appeals, audit preparation, and other duties related to the regulatory reimbursement services of Dignity Health. The position maintains current knowledge of Medicare, Medicaid, and other State and Federal regulations. The Sr. Reimbursement Analyst interacts with customers and ensures value is delivered and customer satisfaction is achieved. The Sr. Reimbursement Analyst also assists in the improvement of internal business processes and meeting future reimbursement service needs.

The Senior Reimbursement Analyst carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of Dignity Health, and fully supports Dignity Health’s Mission, Philosophy, and core values of Collaboration, Dignity, Excellence, Justice, and Stewardship. The Senior Reimbursement Analyst reports to the Reimbursement Managers and/or Directors.

Accountabilities:

1. Prepares interim and annual cost reports for Medicare, Medicaid, and other State or Federal agencies for Dignity Health facilities and regions.
2. Calculates periodic adjustments for deductions from revenue, revenue reserves, bad debt, and other revenue adjustments related to regulatory reimbursement for all Dignity Health facilities and regions in accordance with Dignity Health policies and procedures.
3. Assists the Reimbursement Managers and/or Directors with recommendations for internal Dignity Health strategy by evaluating current growth, anticipating future needs, and assessing the impact of services delivered.
4. Assists in the maintenance of standardized policies and procedures and third-party settlement methodologies.
5. Reviews operational reports, identifies opportunities/problems, and makes recommendations for improving processes.
6. Assesses the impact of new products, technology, and processes on the existing organization and makes recommendations for improvement.

Qualifications

Minimum Qualifications:

• Minimum of five (5) years of experience with all aspects of Medicare and Medicaid (Medi-Cal) regulations monitoring and report processes required.
• Experience as hospital Reimbursement staff or auditing experiences with Fiscal Intermediary required.
• Minimum of five (5) years of experience and excellent working knowledge of general accounting, government reimbursement, appeals, and audits in a complex organization, and maintaining relationships with internal and external entities such as general accounting, patient accounting, and fiscal intermediaries required.
• Experience and knowledge of current reimbursement regulations and applications in a complex healthcare environment required.
• Bachelor’s degree in Business Administration, Accounting or equivalent work experience required.
• Required at times but very limited.