Senior Reimbursement Analyst, Net Revenue

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This position is responsible for the reimbursement of all payers; tasks will include filing compliant cost reports, primary contact on assigned audits, and participating in the month end close process. Advance Excel skills/knowledge is needed in this role. This individual must be able to handle multiple tasks and see each to completion with minimal supervision. Also, responsible for some training of new analyst on department procedures and systems. Effective communication is important, as this role will interact with various departments.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree in business administration, accounting, or finance.

EXPERIENCE:

1. Five (5) years’ of experience in finance or accounting.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.  Advanced degree or Certification in accounting, finance, or healthcare administration

EXPERIENCE:

1. Experience working in a health care or health system environment

2. Experience working with CMS and/or Medicare auditors

3. Experience with EPIC, Workday, Lawson, Strata Jazz  and TOYON Absolute software

4. Advanced computer and spreadsheet skills, primarily in Excel

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Prepare the annual cost reports for Medicare, Medicaid and TRICARE in accordance with government regulations. Analyze reports for increased reimbursement with an understanding of CCR and their impact on reimbursement.

2. Primary contact on assigned hospital audits, work diligently to minimize reimbursement impact to hospital.

3. Assessing the monthly cost estimate for necessary changes or material variances relating to hospital operations throughout the year.  (CAH only)

4. Prepare annual Reimbursement Budget models on assigned hospitals with accuracy using final regulations, and Strata revenue and statistical reports. Serves as a resource to the Reimbursement team.

5. Coordinates the completion and preparation of the annual Uniform Report (UFR) for the WV Healthcare Authority. Serves as a resource to the Reimbursement team.

6. Understanding of Method II reimbursement and the impact on payments and deductions. (CAH only)

7. Understanding of IME/GME, DSH, RHC, bad debts and other medical education programs.

8. Look for opportunities to automate and improve current processes with a goal of increasing accuracy and efficiency.

9. Analyze monthly contractual reserve estimates and communicate to management material changes to A/R. Prepare journal entries.  

10. Assist with the training of new analysts on department procedures and systems.

11. Prepare Medicaid DSH survey and template for DSH Audits. Also, responsible for the review of DSH audit adjustments for accuracy.

12. Primary contact on Wage Index and Occupational Mix audits. Review proposed adjustments from auditors and PUF files for accuracy. (Acute only)

13. Update third party reserves and review monthly supplemental and pass through schedules for accuracy. Prepare necessary journal entries.

14. Verify and analyze interim rate calculations and final settlements by third party payer for accuracy. Responsible for distributing updated rates to internal departments.

15. Promotes and contributes positively to the department by assisting with team members’ questions, contributing ideas and problem solving.

16. Takes a leadership role in performance improvement through planning and implementing change; maintaining and improving productivity through attendance; and participation in staff meetings, committee meetings and cross functional group projects.  

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, lifting, grasping and feeling are necessary body movements utilized in performing duties through the work shift.

2. Must be able to sit for extended periods of time.

3. Must be able to read and write legibly in English.

4. Visual acuity must be within normal range.

5. Must have hearing abilities in order to communicate effectively via telephone and in person.

6. Must have reading and comprehensive ability.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office type environment.

2. Ability to work remotely

SKILLS AND ABILITIES:

1. Cost reporting experience, financial analysis and interpretation of federal and state regulations

2. Good communication skills are necessary to interact effectively with management, staff and external auditors.

3. Excellent computer knowledge and advance Excel skills

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

540 SYSTEM Finance and Reimbursement