Reimbursement Specialist - Medicare & Medicaid Specialty Programs

Responsible for all reimbursement issues

Responsible for all reimbursement issues and reporting any changes in reimbursement regulations. Must be able to prepare supporting documentation and worksheets to support the preparation and completion of the Medicare and Medicaid Cost Reports. Must stay abreast of current Medicare /Medicaid regulation changes and incorporate those into the Cost Reporting. Responsible for providing assistance to related departments regarding reimbursement-related issues.

Qualifications

• Bachelor’s degree in accounting, business administration or closely related field. Required
• Bachelor’s degree in accounting, business administration or closely related field. Preferred

Work Experience

• 3 or more years of Hospital reimbursement or accounting experience. Required
• 1 or more years of experience with preparing hospital cost reports. Preferred

Licenses and Certifications

• Certified Public Accountant (CPA) Preferred

Essential Functions

• Ensures all cost reports (Medicare, Medicaid, TRICARE, etc.) are completed accurately and that corresponding revenue is maximized from both a reporting and programmatic perspective.
• Supplies supporting documentation for cost report during audit. Keeps knowledge current on all Medicare and Medicaid regulations and identifies and implements processes to comply with rules and regulations as well as maximizing revenue from such programs.
• Analyzes impact of changes to Medicare / Medicaid reimbursement regulations and reports estimates to upper management.
• Understands and assists in organizational compliance with all ICTF, DSH, 340b rules and regulations while maximizing organizational revenue from these programs.
• Coordinates the entire ICTF process. Determines ICTF intergovernmental transfer amount and coordinates appropriate filings for receipt of funds. Prepares annual hospital financial survey.
• Knowledge base in regulatory reimbursement/accounting utilized to analyze and develop financial data for profitability studies, budgeted deductions, and other data analysis.
• Accurately and timely completes requests for reimbursement information from both internal and external customers.
• Works with individual departments to maximize Medicare/Medicaid reimbursement.
• Accurately computes and analyzes budgeted deductions from revenue.
• Completes month-end and year-end reimbursement journal entries.
• Provides assistance in analyzing managed care contracts.
• Completes and files government payor provider applications.