Reimbursement Analyst

Overview

The Reimbursement Analyst supports the Director of Finance and the Director of Reimbursement and Cost Analytics in updating and maintaining the cost accounting system and product line reporting. The reimbursement analyst will assist in the preparation and filing of system cost reports. The reimbursement analyst should have expertise in reading and interpreting federal guidelines associated with filing cost reports and the basis for preparing accounting entries every month.

Responsibilities

Participates in the management and evaluation of cost accounting systems. Required to maintain accurate and timely costing and ensure all dictionaries in the system are correct based on the DCH workflow standards.

Produces monthly and quarterly financial reports for executive leaders and department heads for financial analysis and assessment. The analyst should review reports and provide recommendations on improvement opportunities. Meets with key department staff to develop and review relative value units and other statistics for the allocation of costs in the cost accounting system annually.

Responsible for the annual reconciliation of cost accounting and product line data to hospital financial statements. Performs financial pro forma analysis for new or existing business opportunities. Maintains all third-party systems utilized in reimbursement or the finance department.

Prepare work papers, enter data and file the cost reports for the Health System. Ensures reports are prepared in advance for a thorough review and that all reports are filed timely with governing authorities. Analyst should understand basic accounting principles and how to prepare journal entries associated with cost reports and other accounting processes within the department.

Monitor and interpret Federal and State reimbursement regulations, maintain proficiency in using the Federal Register, and maintain a thorough working knowledge of all payer reimbursement principles and regulations. Identify and assist with the implementation of strategic reimbursement initiatives. Assist with financial analysis of new and existing programs related to governmental reimbursement calculations, issues and projections.

Prepare and respond to audits with management oversight from federal or state intermediaries and agencies on open cost reports. Assist in the preparation of the IME GME filings. Computes monthly receivables/payables and prepares journal entries to record the adjustments.

Reconciles Medicare periodic interim payments (PIP) to the general ledger and the monthly Medicare receivable/payable schedule. Computes reimbursement rates for all payers including those for Medicare IPPS, Medicare SNF, Medicare Inpatient Rehab, and Medicare Inpatient Psych. Analyst should have an understanding of reimbursement and billing practices for other commercial and HMO plans.

Periodically reconciles commercial insurance claim payments that are based on a methodology similar to or including Federal government reimbursement principles. Compiles the annual workman's compensation data request used for the annual rate setting. Performs quarterly cash audits.

Performs monthly operating reviews with department heads and assists in budget completion with assigned departments. Prepares business pro formas for new strategic objectives and service line reviews. Prepares wage index projections when CMS releases its proposed and final rules.

Prepares reconciliation of UCP from Final Notice to Cost Report Reconciliation. Works with vendors on special reimbursement initiatives. Completed Medicaid Assister program reporting.

Analyze DRG and APC impact changes. Prepares low-volume adjustments. Two to Four Years Accounting or Finance Experience Preferred.

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.

• Performs compliance requirements as outlined in the Employee Handbook

• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.

• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.

• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.

• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.

• Requires use of electronic mail, time and attendance software, learning management software and intranet.

• Must adhere to all DCH Health System policies and procedures.

• All other duties as assigned.

Qualifications

Education: Bachelor's Degree in Accounting, Business, Finance or Healthcare Administration.

Master's Degree or CPA preferred.

Experience: Two to Four Years of Accounting or Finance Experience preferred.

Two years in an analyst role is preferred.

Prior experience completing cost reports for government programs is preferred.

Must be able to work independently.

Must be able to read, write legibly, speak, and comprehend English.

Must have a passion for change and identifying better ways to do things. Must be an effective communicator and independent worker who will be an industry leader in changing how data and analytics is configured, delivered, and supported.

WORKING CONDITIONS

WORK CONTEXT

• Frequent contact with others: deals with internal and external customers, face-to-face discussions, email and telephone communications. Possible dealings with unpleasant or angry people, public speaking, and conflict situations/resolution.

• Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.

• This job requires very exact and highly accurate performance and may require the meeting of strict deadlines daily.

• May require work hours outside of regular work schedule

PHYSICAL FACTORS

• Activities: Talking, hearing, bending, twisting, walking, kneeling, crouching, stooping, balancing, reaching, pushing, pulling, lifting, grasping, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls

• Requirements: Sedentary work.
  
  Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

• Good manual and finger dexterity.

• Must be able to perform the duties with or without reasonable accommodation.

• Hearing and vision must be normal or corrected to within normal range.