Reimbursement Specialist- Government Reporting

Position:                              Reimbursement Specialist
Department:                        Clinical Revenue & Reimbursement

Function:
The Reimbursement Specialist performs advanced reporting and analysis of institutional financial data related to government reimbursement and government reporting requirements. Responsibilities include reporting on institutional expenses, revenue, and operations typically related to patient care, in support of requests and requirements from various governmental and oversight agencies, as well as internal customers.  Serves as primary point of contact for the institution’s efforts on reporting uncompensated care.  Provides secondary support of Medicare and Medicaid cost reporting efforts, as needed.  Reports on both technical and professional data, interacting with all levels of institutional personnel.  Knowledge base should include techniques for proper accounting, forecasting, accounting information systems, financial analysis, decision support, hospital finance, and organizational effectiveness.  This position requires the ability to translate federal and state rules and regulations into practice; broad information system user skills; good judgment and independent decision-making abilities; excellent interpersonal and communication skills; and the ability to function under pressure due to time constraints and audits.

Scope:
This position impacts the institution’s ability to maximize appropriate third-party reimbursement opportunities and interacts with multiple levels of staff and leadership throughout the organization, and occasionally outside of the organization, to communicate and coordinate efforts related to government reimbursement and reporting.

ESSENTIAL FUNCTIONS:

Financial Reporting – Government Programs and Surveys (50%)
•    Performs extensive analyses to facilitate accurate and compliant reporting in support of a variety of programs and reporting requirements related to government reimbursement and uncompensated care.
           o Uncompensated Care Reporting, including support of the institutional Uncompensated Care Advisory Committee, Annual Statement of Community Benefits Report, annual UC/DSH reporting, and various other reports related to uncompensated care.
           o Supports various national and local surveys, including the AHA survey.

Cost Report Preparation & Defense (30%)
•    Supports reporting efforts for the Medicare and Medicaid costs reports.  Prepares and analyzes any aspects of Medicare reimbursement including:
          o Coordination and preparation of the annual cost reports and the supporting documentation.
          o Preparation and analysis to validate and test new techniques of cost finding.
          o Preparation and reconciliation of various analyses and schedules, such as PIP, PS&R, space allocation, and other analyses.
•    Prepare & analyze workpapers used in the entire Medicare audit process.
          o Provide voluminous supporting documentation needed to defend the hospital’s position upon cost report audit, reviewing of audit adjustments for reopening opportunities, and appealing of disputed issues.
          o Review Intermediary workpapers and translate audit results to impact analysis. Incorporate all prior year audit year adjustments into current filings.

Other Reimbursement Analysis & Support (20%)
•    Manages large amounts of data in an efficient manner.
•    Performs pro forma modeling, retrospective analyses, and other analyses and projects 
      as required.
•    Calculates allocation of Medicare lump-sum payment to apply for reporting total Medicare reimbursement on Medicare patient accounts
•    Remains abreast of new regulatory and/or requirement changes by monitoring the Medicare Administrative Contractor (MAC) and CMS websites.
•    Thoroughly documents analysis work for consistency and reproducibility.

Supervision

Received:         Associate Director, Finance or Manager, Finance