Reimbursement Analyst- Audit and Regulatory

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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.

OR

2. 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 workpapers, schedules, and forms and updates workpapers, 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 efficiency.

11. Assists with completion, analysis, and submission of Medicaid DSH Survey and DSH audit annually. Conducts all necessary analysis and opportunity/risk assessment and develops reporting and technical efficiencies and strategies.

12. Analyzes data and compiles supporting documentation for Wage Index and Occupational Mix, transplant, Nursing and Allied Health, Bad Debt, Charity Care, S-10, desk review, IME/GME Overlap, time studies/time allocation, etc. and develop technical and reporting efficiencies and improvements. Directly responsible for answering questions during the review/audit of these and any other items, providing supporting documentation and rationale, data entry, template compliance, invoice research and compilation, etc.  

13. Provides necessary data and support to the reimbursement team to calculate third party receivables and payables as needed.

14. Provide analytical interpretation and substantiation during the Hospital’s annual financial audit and annual governmental audits as needed in addition to any other support that be required

15. Coordinates reimbursement projects with various consultants as dictated by the needs and requirements of the project and the department.

16. Participates in meeting the objectives of the work unit and goals of the department.

17. Promotes and contributes positively to the teamwork of the department by assisting co-workers, contributing ideas and problem-solving with co-workers.

19. Identifies and addresses problems, questions, concerns, analysis, etc. in a timely manner so that proper actions can be implemented to prevent losses, maximize reimbursement, and meet deadlines, to facilitate the growth and stability of the organization.

20. Provides any other support to the Finance and Reimbursement Department as needed and coordinates activity with department leadership

21. Must be able to operate independently in a highly efficient and effective manner and replicate prior year workpapers, support, documentation, etc. as required without direct oversight or other involvement from leadership or other staff.

22. Effectively communicate and collaborate in a team atmosphere to fulfill their responsibilities and meet deadlines utilizing excellent communication skills, prioritization, critical thinking, and data analysis skills

23. Support performance improvement and quality assurance initiatives.

24. Participate in educational opportunities as provided by the hospital to enhance skill related abilities.

 

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, lifting, grasping and feeling are necessary body movements utilized in performing duties through the work shift.

2. Must be able to sit for extended periods of time.

3. Must be able to read and write legibly in English.

4. Visual acuity must be within normal range.

5. Must have hearing abilities in order to communicate effectively via telephone and in person.

6. Must have reading and comprehensive ability.

 

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office type environment.

2. Ability to work remotely.

 

SKILLS AND ABILITIES:

 

1. Extensive experience in financial analysis and interpretation of federal and state regulations.

2. Specialized knowledge of hospital healthcare reimbursement, including but not limited to cost reporting, bad debt (including the reserve and posting process), S-10, Wage Index/Occupational Mix, DSH, 340b, and rate setting.

3. Strong communication skills are necessary to interact effectively with management, staff and external auditors.

4. Excellent analytical, critical thinking, and problem-solving abilities with the ability to manipulate and understand complex information and robust data sets and calculations.

5. Effective organizational and time management skills with the proven ability to meet deadlines with precision, intention, and efficiency.

6. Proficiency in Microsoft Office Suite (Excel, Access, Word, Outlook) and other fundamental computer skills.

7. Ability to work effectively and independently managing tasks in a fast-paced environment.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Day (United States of America)

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

540 SYSTEM Finance and Reimbursement