Lead Reimbursement Analyst - Finance

Finance Position Overview

Perform the calculations and analysis of accounts receivable and valuation and third party reimbursement reporting, coordination of audits and monitoring of regulation changes. With minimal supervision prepares and files the Medicare and Medicaid cost reports and Blue Cross cost studies to ensure the maximization of reimbursement received by UAB St. Vincent's Health System; acts as liaison between Hospital and local intermediary;

prepares quarterly mini cost reports; and prepares monthly journal entries for reimbursement adjustments.

• Assist in the preparation, review, and filing of Medicare and Medicaid cost reports.
• Review supporting schedules and coordinate with external advisor and fiscal intermediary for preparation of annual reports.
• Ensure compliance with CMS regulations, state Medicaid rules, and payer-specific requirements.
• Prepare applications and accounting for any state supplemental payment programs.
• Prepare reports and prepare month end journal entries in general ledger.
• Maintain documentation supporting reimbursement calculations and regulatory filings.
• Prepare Retro models.
• Analyze payer reimbursement methodologies including Medicare, Medicaid, managed care, and commercial contracts and calculates financial impact of changes in reimbursement.
• Prepare reimbursement calculations and projections for inpatient, outpatient, physician, and ancillary services.
• Identify reimbursement variances, underpayments, and revenue opportunities; recommend corrective actions.
• Support managed care contract analysis, modeling, and negotiation preparation.
• Assist with modeling proposed contract changes and renewals.
• Reconcile reimbursement payments to expected rates.
• Partner with Revenue Cycle, Patient Financial Services, and Clinical departments to resolve reimbursement issues.
• Serve as a reimbursement subject-matter resource for internal stakeholders.
• Participate in audits, appeals, and payer inquiries as needed.
• Assist the manager and director with budgeting and modeling net patient service revenue.
• Performs other duties as assigned.

Licenses / Certifications

• Accountant licensure required relevant to state in which work is performed preferred.

Education:

• Bachelor's degree in Finance, Accounting, Healthcare Administration, Business, or related field required.
• 2 years of healthcare reimbursement, revenue cycle, or financial analysis experience required
  • 4 years preferred.

Knowledge/Skills/Abilities:

• Strong written and verbal communication skills.
• Proficiency in Excel (pivot tables, formulas, data analysis).
• Strong analytical, quantitative, and problem-solving skills.
• Knowledge of Medicare and Medicaid reimbursement methodologies.