Reimbursement Analyst

Reports to the Controller and/or Director of Accounting. Ensures that reimbursement and case mix transactions are in accordance with the appropriate CMS, state and contractual requirements, as well as, prepares analysis of proposed reimbursement changes. Provides proactive assessments to the Manager of Reimbursement and Controller of potential or actual contractual or legislative changes to reimbursement. Also programs reports to access the health systems data base, prepares and maintains appropriate worksheets and journal entries and prepares the Medicare cost reports for Beacon Health System.

• MISSION:
  We deliver outstanding care, inspire health, and connect with heart.
• VALUES:
  Trust. Respect. Integrity. Compassion.
• SERVICE GOALS:
  Personally connect. Keep everyone informed. Be on their team.

• Reviewing 835 files for errors and researching or problem solving for any errors found.
• Preparing and updating month end contractual analysis for general ledger reporting.
• Preparing analysis of the impact of proposed reimbursement changes for governmental and commercial payors.
• Programming computer reports from the Health System’s financial, payroll and third party billing systems, as needed to be utilized in the reimbursement analysis process and reporting to Beacon Health System's Managed Care Department.
• Preparing monthly transaction code and accounts receivable reports for review.
• Maintaining accurate reimbursement tables in the various reimbursement software programs.
• Setting up contracts and governmental payor reimbursement on applicable software for contract and denial management and updating as contracts or reimbursement change.
• Testing software prior to updates or new version installation to insure accuracy as related to reimbursement and contractual calculations.

• Maintaining statistical worksheets.
• Preparing support worksheets for cost report and wage index sections.
• Contacting other departments to obtain necessary information.
• Ensuring that information is received and inputted into the cost report software program in a timely manner.
• Maintaining cost report files and ensuring that appropriate cost report software updates are installed.
• Assisting in the preparation of both Medicare and Medicaid cost report appeals of prior year findings by researching and documenting the appropriate information in the approved CMS format.
• Prepares work papers to support applicable third party labor for inclusion in wage index, inclusive of contacting third parties for necessary information.

• Preparing related work papers as requested.
• Answering auditor questions and researching issues as they arise.
• Obtaining requested information and document copies.

• Writing computer reports from People Soft, PIC and McKesson as required by other departments.
• Preparing reports for information as requested by the Manager of Reimbursement and other management staff.
• Prepares reimbursement analysis for specific requests.

• Completing other job-related assignments and special projects as directed.
• Designs and creates reports from computer systems to analyze accounts receivable data and costs versus reimbursement for services provided.

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established time frames.
• Completes annual employee health requirements within established time frames.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey…