Reimbursement Analyst- Audit and Regulatory

## Welcome! We’re excited you’re considering an opportunity with us!

To apply to this position and be considered, click the Apply button located above this message and complete the application in full.  Below, you’ll find other important information about this position.

The primary focus of this position is to analyze and provide data from various sources in order to address cost report and other reimbursement filing audits, reviews, rate adjustments, etc. as required by regulatory agencies, law/legislation. Extensive knowledge of third-party reimbursement regulations is required in order to respond and provide accurate support and to inform management and other areas of the organization of the impact of changing reimbursement regulations, audits, reviews, etc.

Excellent communication skills are imperative to coordinate information from various levels of the organization, with Medicare and Medicaid auditors, external vendors, etc. Must be able to use critical thinking and analysis skills, experience, and insight to promptly, accurately, and effectively address issues, questions, complete projects, meet deadlines, etc. without direct management or other leadership involvement. Must be able to operate independently in highly efficient and effective manner.
** MINIMUM QUALIFICATIONS****:
**** EDUCATION, CERTIFICATION, AND/OR LICENSURE:
** 1. Bachelor’s Degree.

OR2. HFMA Certified Hospital Cost Report Specialist (CHCRS).
*
* EXPERIENCE:

** 1. Successful completion and submission of Medicare Cost reports for two or more (2+) years for Critical Access and/or Acute/IPPS facilities and successful navigation of at least two (2+) years of corresponding reviews, surveys, and audits (Interim rate reviews, S-10, Bad Debt, Charity Care, DSH, Wage Index, Occupational Mix, desk review, etc.)2.

Experience with hospital electronic health record systems (EPIC, Cerner, etc.), Cost Reporting applications, general ledger/accounting systems, and CMS/MAC cost reporting procedure, process, completion, submission, supporting schedules and documentation requirements, regulation, strategy, and audit.
3.  Advanced computer and spreadsheet skills, primarily in Excel.
** PREFERRED QUALIFICATIONS****:
***
* EXPERIENCE:

** 1. Three (3) experience in healthcare accounting (general ledger, trial balance, income statement, balance sheet, cash flow, etc.), finance, revenue cycle, data analysis, and/or reimbursement.
** 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. Supports all third-party cost reports (Medicare, WV Medicaid, PA Medicaid, Ohio Medicaid, Champus/Tricare, etc.) and any analysis, updates, changes, etc. to facilitate any necessary amendments as needed. Directly supports audits/reviews of these reports and any other associated audits (including but not limited to Wage Index, Occupational Mix, DSH, S-10, Bad Debt, Charity Care, NAHE, and DGME/IME). Coordinates within the department to address and support any applicable review/audit.
2. Coordinates compiling of all data required for completion of any audits from various departments systems and external sources. Provides updates on status and monetary impact of all filings/deadlines, settlements, amendments, audits, adjustments, etc. and regularly tracks, updates, and communicates with necessary parties regarding any and all reimbursement items.
3. Conducts research and provides documentation and explanations for all necessary work papers, schedules, and forms and updates work papers, schedules, applications and software (including but not limited to Absolute, and HFS systems/files) promptly and accurately. Performs all necessary reimbursement impact analysis, technical completion/submission review, analysis, and strategy and identifies strategy. methodology, and efficiencies to minimize losses and improve reimbursement as well as regulatory/audit risk and/or opportunity.
4. Analyzes data from all sources to ensure accuracy, consistency, and technical correctness in accordance with all regulatory and audit requirements/interpretations.
5. Assists with and prepares reimbursement budget models with accuracy using the most current, proposed and final regulations.
6. Assists with and prepares the Uniform Report for the WV Healthcare Authority annually as needed.
7. Analyzes current rate structure and develops current and future impact based on reviews/audits in addition to reconciling adjustment impact prior to acceptance. Responsible for distributing updated rates and estimated impact to internal departments.
8. Maintain and continually improve on technical skills needed to manipulate and analyze data.
9. Utilize and develop database report writing skills in Strata and other systems as needed. Analyze current report setup/processes for accuracy and…