Job Details

Sr. Reimbursement Analyst / Medicare Medicaid Cost Reports

This is a 100% remote work-from-home position

Essential Duties & Functions:

• Collects, analyzes all underlying data and prepares supporting documentation for the Medicare cost report Worksheet S-10. Reviews outside consultant logs and schedules. Reviews audit adjustments for accuracy.
• Prepares additional provider research files and reviews outside consultant logs for the Medicare cost report Medicaid DSH eligibility.
• Prepares the Medicare cost reports Traditional Medicare Bad Debt and Dual Eligible logs.
• Prepares the Medicare cost report Wage Index. Reviews audit adjustments for accuracy.
• Prepares the calculation of accounts receivable and third-party reserves including the timely submission of the monthly journal entry along with additional analyses as needed.
• Collects and analyzes all underlying data and prepares the Medicaid pending conversion calculations.
• Prepares 340 B trial balances for inclusion with the annual HRSA submissions.
• Prepares Medicare gain/loss analysis for Schedule H of Form 990.
• Assists in the annual net revenue budget and three-year forecasting process. Research and completion of all governmental modeling is the primary focus.
• Assists with the preparation of E&Y audit workpapers.
• Reviews CMS/MAC rate reviews and audit adjustments for accuracy.
• Prepares amended Medicare and Medicaid cost reports and Tricare capital and direct medical education reports and supporting schedules as needed.
• Reviews tentative cost report settlements and final cost report settlements including audit adjustments for accuracy.
• Prepares Medicare and Medicaid reimbursement factors and reimbursement calculators for Inpatient, Outpatient, Psych, and Rehab.
• Collects and analyzes all underlying data in conjunction with the Rehab Unit and prepares the submission for the Inpatient Rehab Unit 75% compliance report for exemption from the Inpatient Prospective Payment System.
• Collects and analyzes all underlying data, prepares all supporting documentation, and submits in a timely and accurate manner the Medicare occupational mix surveys. Reviews audit adjustments for accuracy.
• Prepares HCAP logs and obtains supporting documentation for independent consultant review. Also, prepares the matching data in the formats used for the Medicaid cost report.
• Prepares Myers & Stauffer logs for the federal DSH audits that match the Medicaid cost report in the required format in a timely and accurate manner.
• Submits documentation for the Kentucky Workers' Compensation Hospital Fee Schedule cost-to-charge ratio calculation.
• Collects all underlying data, prepares detail and summary invoices, and payment reconciliations for the Montgomery County Indigent Ill Levy submissions.
• Acts as a liaison between Reimbursement and the report writing team to assist in regulatory data revisions.
• Prepares detailed analysis of regulatory changes to determine the reimbursement impact to PHP.
• Ensures compliance with Federal and State laws when using PHP provider numbers, including Provider Based Status rules.
• Maintains current working knowledge of Medicare, Medicaid, and other regulations. Assists in providing education with Federal rules and regulations.

Education:

Minimum Level of Education Required: Bachelor's Degree in Business Administration majoring in Accounting, Finance or related business field required.

Experience:

3-5 years of job-related experience required. Hospital reimbursement required, including Medicare and Medicaid cost report experience required. Current working knowledge of the financial statement process, running ad-hoc patient financial system and/or general ledger financial reports, and strong financial skills required. Experience in Medicare medical education reimbursement (IME/DGME) and Medicare provider enrollment system (PECOS) preferred.