Job Description

PURPOSE OF POSITION:

The Sr. Reimbursement Analyst will assist the Director by analyzing and presenting data from a variety of sources which will advance the goals and objectives of the organization and ensure that the net revenue for the system is correctly stated. The Analyst will also ensure that third-party reimbursement is maximized by filing reports correctly and responding to all requests timely.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Utilize accounting/finance and PC knowledge to prepare expense, revenue and statistical schedules required for completion of the annual Cost reports; CMS-2552, CHIA Hospital Cost Reports, CMS-2540, CMS 287-22 , CMS 1728, State UCCR reports, CHIA SNF-CR and MGT-CR, and CHIA Home Health cost report.
• Prepare monthly contractual reserve models
• Utilize expertise with PC based relational database and spreadsheet systems to analyze third party contractual allowances and propose adjustments, as necessary.
• Responsible for monitoring and reporting changes in various elements of care such as shift in IP and OP utilization, ALOS, patient acuity, payments, discharge disposition and payer mix, ensuring that systems are in place to capture data to facilitate such analysis.
• Work collaboratively with IT and BI to automate data extracts needed for governmental reporting.
• Prepare independent analysis of available data to identify potential areas of improvement by comparing actual performance to established norms and benchmarks.
• Prepare documentation and net revenue analysis required for the year-end financial audits.
• Work with Medicare auditors to ensure successful annual audits of the cost reports and any components audited separately.
• Assist in the development of the annual net revenue budget.
• Prepare analysis and documentation for all other government reporting and follow up as required by Federal and State Regulations.
• Analyze the impact of changes in Medicare and MassHealth (EOHHS) Regulations as well as for other third-party insurers.
• Perform other work-related duties as assigned or requested.
• Challenges current working practice; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

EDUCATION/EXPERIENCE/TRAINING :

• Minimum of bachelor’s degree in accounting preferred or equivalent combination of education and experience in Reimbursement
• 5 - 7 years’ experience in acute care hospital finance/accounting.
• Knowledge and experience in the following areas: Accounts Receivable analysis, developing financial models, payer contracts and reimbursement analysis, and accounting.
• Excellent analytical skills.
• Excellent PC skills: MS Access, Excel or comparable PC based database skills required.
• Ability to work with minimum supervision.
• Ability to meet deadlines.

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