Sr. Reimbursement Consultant- Medicare/Medicaid

Orlando Health, Inc.; Orlando (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Orlando Health is seeking a Financial Analyst to manage the creation, execution and refinement of financial analysis, processes, accounting and reporting for reimbursement activities across assigned facilities. You will ensure accurate submission of Medicare cost reports and support audits and regulatory changes.

The role requires strong knowledge of reimbursement systems, cross-functional collaboration and a commitment to compliance with evolving regulations.

Qualifications

• Bachelor’s degree in Accounting, Finance or Business Administration preferred but not required.

Responsibilities

• Prepares Medicare cost reports and amendments for hospitals in accordance with regulations.
• Coordinates audits of Medicare cost reports and supports external reviews.
• Maintains knowledge of reimbursement regulations and implements process improvements to optimize reimbursement.

Education

Accounting degree

Job description

Position Summary

About Orlando Health:

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our dedicated team members serve communities that span Florida’s east to west coasts, Central Alabama and Puerto Rico.

Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not just something we say, it’s our promise to you.

Position Summary:

Responsible for creation, execution and refinement of financial analysis, processes, accounting, and reporting for reimbursement activities for assigned hospitals

Responsibilities

Essential Functions

• Responsible for accurate preparation and submission of health system Medicare and the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) cost reports and amendments, re-openings and appeals, if applicable, in accordance with State and Federal regulations.
• Provides specific expertise in the areas of Medical Education, Bad Debts, DSH, Wage Index, and S-10 reporting for the complex health system.
• Coordinates procurement/completion of time studies, rotation schedules, statistics, available bed counts, and bad debt logs throughout the fiscal year needed to complete cost reports. Provide support for any external reviews done to optimize reimbursement, such as DSH, BD, WI, and S-10.
• Coordinates any health system audits conducted by or on behalf of Medicare and/or Medicaid agencies, and challenges adverse adjustments. Communicates with the appropriate levels of governmental auditors as appropriate and review documentation to ensure appropriate reimbursement.
• Maintains knowledge of current regulations and reviews proposed changes that impact the health system's reimbursement. Disseminate changes in reimbursement to the appropriate levels of management to fosterinformed decision-making and compliance with laws and regulations. Assists with development of any record-keeping policies and procedures required by new/changing regulations or payment methods.
• Prepares the annual State DSH/LIP Surveys, 990 Schedule H, and other required filings and related audit defense.
• Maintains updated enrollment records and submits revalidations and provider-based attestations for new and existing facilities and services. Provides any needed support for the enrollment of any additional 340B sites. Monitors area wage index and file MGCRB reclassification requests if beneficial.
• Calculates and analyzes third-party settlement balances and reserves on a monthly/annual basis and make applicable adjustments. Provides documentation during year-end financial audits that support third-party receivables/payables, such as detailed workpapers and MAC correspondence.
• Identifies and implements process improvement opportunities while always looking for ways to optimize reimbursement.
• Participates in project teams to provide reimbursement expertise necessary in the decision-making process. Conducts reimbursement impact analyses and prepares provider comment letters to propose regulatory changes that are submitted to CMS for consideration. Performs other projects as assigned.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

• Effectively communicates complex financial models to a wide variety of audiences through verbal and written presentations.
• Manages large projects and oversees leadership of cross-functional teams.
• Participate in/attend meetings as required. May be asked to chair or lead meetings.
• Complete all Orlando Health mandatory education.
• Assumes responsibility for professional development and continuing education.

Qualifications

Education/Training

Bachelor’s degree in Accounting, Finance or Business Administration preferred but not required.

Licensure/Certification

CPA preferred but not required.

Experience

5 years of experience in preparing Medicare cost reports in a hospital system or consulting firm. Experience in coordinating audits of Medicare cost reports. Ability to use various reimbursement software and Microsoft Office applications. Database, HFS, SQL, Absolute, Lawson, and EPIC experience a plus