Reimbursement Analyst

JOB_REQUIREMENTS

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Reports to the Controller and/or Director of Accounting. Ensures that reimbursement and case mix transactions are in accordance with the appropriate CMS, state and contractual requirements, as well as, prepares analysis of proposed reimbursement changes. Provides proactive assessments to the Manager of Reimbursement and Controller of potential or actual contractual or legislative changes to reimbursement. Also programs reports to access the health systems data base, prepares and maintains appropriate worksheets and journal entries and prepares the Medicare cost reports for Beacon Health System.

MISSION, VALUES and SERVICE GOALS

MISSION: We deliver outstanding care, inspire health, and connect with heart.
VALUES: Trust. Respect. Integrity. Compassion.
SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Maintains reimbursement information by:

Reviewing 835 files for errors and researching or problem solving for any errors found.
Preparing and updating month end contractual analysis for general ledger reporting.
Preparing analysis of the impact of proposed reimbursement changes for governmental and commercial payors.
Programming computer reports from the Health System’s financial, payroll and third party billing systems, as needed to be utilized in the reimbursement analysis process and reporting to Beacon Health System's Managed Care Department.
Preparing monthly transaction code and accounts receivable reports for review.
Maintaining accurate reimbursement tables in the various reimbursement software programs.
Setting up contracts and governmental payor reimbursement on applicable software for contract and denial management and updating as contracts or reimbursement change.
Testing software prior to updates or new version installation to insure accuracy as related to reimbursement and contractual calculations.

Preparation of Medicare Cost Reports and Wage Index preparation by:

Maintaining statistical worksheets.
Preparing support worksheets for cost report and wage index sections.
Contacting other departments to obtain necessary information.
Ensuring that information is received and inputted into the cost report software program in a timely manner.
Maintaining cost report files and ensuring that appropriate cost report software updates are installed.
Assisting in the preparation of both Medicare and Medicaid cost report appeals of prior year findings by researching and documenting the appropriate information in the approved CMS format.
Prepares work papers to support applicable third party labor for inclusion in wage index, inclusive of contacting third parties for necessary information.

Assists in year-end and cost report audits by:

Preparing related work papers as requested.
Answering auditor questions and researching issues as they arise.
Obtaining requested information and document copies.

Provides inter-departmental support by:

Writing computer reports from PeopleSoft, PIC and McKesson as required by other departments.
Preparing reports for information as requested by the Manager of Reimbursement and other management staff.
Prepares reimbursement analysis for specific requests.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

- Completing other job-related assignments and special projects as directed.
- Designs and creates reports from computer systems to analyze accounts receivable data and costs versus reimbursement for services provided.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

Attends and participates in department meetings and is accountable for all information shared.
Completes mandatory education, annual competencies and department specific education within established timeframes.
Completes annual employee health requirements within established timeframes.
Maintains license/certification, registration in good standing throughout fiscal year.
Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
Adheres to regulatory agency requirements, survey process and compliance.
Complies with established organization and department policies.
Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

Leverage innovation everywhere.
Cultivate human talent.
Embrace performance improvement.
Build greatness through accountability.
Use information to improve and advance.
Communicate clearly and continuously.

Education and Experience

The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor's degree in Business Administration with a concentration in Accounting, Finance or other related field. Prefer a minimum of three years of experience in the healthcare reimbursement and cost accounting field is required.

Knowledge & Skills

Demonstrates professional knowledge of the accounting process.
Requires advanced knowledge of Medicare/Medicaid and managed care payment systems, as well as technical cost report issues.
Requires the ability to operate a personal computer and utilize a spreadsheet software program (i.e., MS Excel).
Requires the analytical skills necessary to program reports from the Hospital data base, using specialized software; analyze financial data extracted and develop reports.
Demonstrates the interpersonal and communication skills (both verbal and written) necessary to elicit cooperation and support from others and to interact tactfully and effectively with co-workers, management staff and other external contacts, in a clear, concise manner.
Demonstrates knowledge of and a commitment to Beacon Health System’s mission and values; and the organization’s goal of providing exceptional patient experiences by following the Performance Essentials.

Working Conditions