Reimbursement Analyst- Audit and Regulatory

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The primary focus of this position is to design reports and analyze data from various sources in order to prepare cost reports and other reimbursement filings as required by regulatory agencies. Good communication and problem-solving skills are imperative to organize information from multiple sources to coordinate with management, and complete assigned projects. The Reimbursement Analyst should have a working knowledge of third-party reimbursement to facilitate working with external auditors and other internal departments.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree in business administration, accounting, or finance

EXPERIENCE:

1. Three (3) years’ of experience in finance or accounting

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Experience with Medicare Cost Reporting.

2. Experience with monthly deduction calculations

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. Prepares all third party cost reports (Medicare, WV Medicaid, PA Medicaid, Ohio Medicaid & Champus) and amends any cost report as needed. Then coordinates the audits of these reports.

2. Coordinate gathering all data required for completion of cost reports from various departments, systems and external sources.

3. Analyzes data from all sources to ensure accuracy and consistency.

4. Prepares reimbursement budget models with accuracy using the most current proposed and final regulations.

5. Prepares the Uniform Report for the WV Healthcare Authority annually and can resolve variances independently

6. Verify and analyze interim rate calculations and final settlements by third party payors for accuracy.

7. Maintain and continually improve on technical skills needed to manipulate data.

8. Prepare requested data for various consultant reimbursement project

9. Maintain intermediate report writing skills in Strata and other systems as needed.

10. Maintains all third party cost report computer software systems, including installing all updates.

11. Review state and federal regulations and other reimbursement education publications to analyze the reimbursement impact of regulatory changes on the hospital and become an expert on issues related to Medicare and Medicaid reimbursement.

12. Compiles all data for the Medicaid DSH Survey and DSH audit annually. Then reviews all DSH audit adjustments for accuracy.

13. Prepares monthly contractual reserve analysis by gathering all necessary data, manipulating the data, reviewing for accuracy and proposing necessary journal entries.

14. Prepares data for Wage Index reviews and Occupational Mix surveys as assigned. Answers all questions during the review of these items and analyzes all proposed adjustments from Medicare.

15. Calculates third party receivables and payables monthly. Prepares any necessary journal entries and maintains detailed schedules of all calculations.

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.

18. Participates in performance improvement through planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, committees, task forces, cross functional groups, projects and discussion with hospital management and staff.

19. Complete interim rate request form on assigned hospitals. Responsible for distributing updated rates to internal departments.

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. Direct experience in cost reporting, financial analysis and interpretation of federal and state

2. Good communication skills are necessary to interact effectively with management, staff and external auditors.

3. Extensive knowledge of personal computers and Excel

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

540 SYSTEM Finance and Reimbursement