Senior Reimbursement Analyst Job in Pasadena, California US
Senior Reimbursement Analyst
The Senior Reimbursement Analyst, Hospital Reimbursement is responsible for the Hospital Medicare and Medi-Cal regulatory filings and compliance to CMS reimbursement regulations for hospital based regions (NCAL, SCAL, Northwest and Hawaii). This position will also oversee all aspects of internal, external, and regulatory audits to include serving as the liaison between the hospitals and the auditor. In addition, the Senior Reimbursement Analyst will file appeals with appropriate regulatory agencies as a result of any disputed audit items and will oversee the process until resolution is reached. Essential Functions: -Responsible for the accurate and timely filing of Medicare, Medicaid and CHAMPUS cost reports for both hospital and non-hospital providers. This includes preparing the cost report in accordance with Federal and State regulations. Ensuring all corresponding supplemental schedules and questionnaires are timely filed as requested by regulatory agencies. Amend reports as needed immediately after discovery of omissions or errors. - Oversee internal, external, and regulatory audits and serve as a liaison between the hospitals and the auditor. Assist the auditor in answering any questions and providing explanations throughout the audit. Provide proper supporting documentation to minimize unfavorable adjustments. Ensure regulations are correctly applied and/or interpreted by the auditor. Communicate audit findings to appropriate parties in the organization and provide financial impact and future procedural changes due as a result of the findings. Follow through with any cost report reopenings in order to resolve open items. - The Senior Reimbursement Analyst is responsible for appealing any audited cost reports where disputes exist in the appropriateness of any adjustments made to the cost report. Submit timely appeal letters, position papers, and any other documents necessary to reach a resolution to the appeal. - Prepare trend reports, analyze financial data, and explain variances between cost report years, other hospitals, and state and national averages to assist management with planning and decision making. May also coordinate, compile, and distribute key data from the cost reports to management or as requested by other individuals in the organization. - This position will also participate in or lead other projects and analyses as needed. Will research various cost report and reimbursement issues and determine how the hospitals may be impacted. Will educate the reimbursement team or other departments on any new regulatory changes. - Prepares special studies, analyses, and other ad hoc projects. - Partners and collaborates with other departments outside of NMF in achieving the department's overall goals and objectives. Consistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements. Qualifications: Basic Qualifications: -Five or more years of financial analysis or related experience. - Bachelor's degree in finance related field or equivalent experience. - Broad application of financial analysis principles, theories, and concepts in applicable discipline, plus working knowledge of other related fields. - Advanced proficiency in PC based word processing and spreadsheet applications, including advanced functions such as graphics, pivot tables, macros and database management. - Thorough knowledge of financial analysis policies, practices and systems. - Complete understanding and application of financial analysis principles, concepts, practices, and standards. - Highly developed knowledge of finance theories such as present values theory/cash flow analysis and accounting principles. - Able to formulate finance study designs and prepare and conduct professional presentations. - Full knowledge of industry practices and standards. Preferred experience: - Eight or more years of reimbursement experience to include multi-hospital cost report preparation. - Audit experience in a regulatory environment. - Significant knowledge of laws and regulations governing Medicare reimbursement. -Experience with working large data sets, operational data and with health care statistics - Experience with HFS and other reimbursement applications. - Experience in compliance activities. - Demonstrated application of financial analysis and financial reporting. - CPA / CMA - Master's degree in related field.