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WVU Medicine · 20 hours ago

Reimbursement Analyst- Audit and Regulatory

United States

Full-time

Remote

Mid, Senior Level

2+ years exp

WVU Medicine is a healthcare organization that seeks a Reimbursement Analyst to analyze and provide data for cost report and reimbursement filing audits. The role requires extensive knowledge of third-party reimbursement regulations and excellent communication skills to coordinate information across various levels of the organization.

Health CareHospitalMedical

Responsibilities

Supports all third-party cost reports (Medicare, WV Medicaid, PA Medicaid, Ohio Medicaid, Champus/Tricare, etc.) and any analysis, updates, changes, etc. to facilitate any necessary amendments as needed. Directly supports audits/reviews of these reports and any other associated audits (including but not limited to Wage Index, Occupational Mix, DSH, S-10, Bad Debt, Charity Care, NAHE, and DGME/IME). Coordinates within the department to address and support any applicable review/audit

Coordinates compiling of all data required for completion of any audits from various departments systems and external sources. Provides updates on status and monetary impact of all filings/deadlines, settlements, amendments, audits, adjustments, etc. and regularly tracks, updates, and communicates with necessary parties regarding any and all reimbursement items

Conducts research and provides documentation and explanations for all necessary workpapers, schedules, and forms and updates workpapers, schedules, applications and software (including but not limited to Absolute, and HFS systems/files) promptly and accurately. Performs all necessary reimbursement impact analysis, technical completion/submission review, analysis, and strategy and identifies strategy. methodology, and efficiencies to minimize losses and improve reimbursement as well as regulatory/audit risk and/or opportunity

Analyzes data from all sources to ensure accuracy, consistency, and technical correctness in accordance with all regulatory and audit requirements/interpretations

Assists with and prepares reimbursement budget models with accuracy using the most current, proposed and final regulations

Assists with and prepares the Uniform Report for the WV Healthcare Authority annually as needed

Analyzes current rate structure and develops current and future impact based on reviews/audits in addition to reconciling adjustment impact prior to acceptance. Responsible for distributing updated rates and estimated impact to internal departments

Maintain and continually improve on technical skills needed to manipulate and analyze data

Utilize and develop database report writing skills in Strata and other systems as needed. Analyze current report setup/processes for accuracy and efficiency

Assists with completion, analysis, and submission of Medicaid DSH Survey and DSH audit annually. Conducts all necessary analysis and opportunity/risk assessment and develops reporting and technical efficiencies and strategies

Analyzes data and compiles supporting documentation for Wage Index and Occupational Mix, transplant, Nursing and Allied Health, Bad Debt, Charity Care, S-10, desk review, IME/GME Overlap, time studies/time allocation, etc. and develop technical and reporting efficiencies and improvements. Directly responsible for answering questions during the review/audit of these and any other items, providing supporting documentation and rationale, data entry, template compliance, invoice research and compilation, etc

Provides necessary data and support to the reimbursement team to calculate third party receivables and payables as needed

Provide analytical interpretation and substantiation during the Hospital’s annual financial audit and annual governmental audits as needed in addition to any other support that be required

Coordinates reimbursement projects with various consultants as dictated by the needs and requirements of the project and the department

Participates in meeting the objectives of the work unit and goals of the department

Promotes and contributes positively to the teamwork of the department by assisting co-workers, contributing ideas and problem-solving with co-workers

Identifies and addresses problems, questions, concerns, analysis, etc. in a timely manner so that proper actions can be implemented to prevent losses, maximize reimbursement, and meet deadlines, to facilitate the growth and stability of the organization

Provides any other support to the Finance and Reimbursement Department as needed and coordinates activity with department leadership

Must be able to operate independently in a highly efficient and effective manner and replicate prior year workpapers, support, documentation, etc. as required without direct oversight or other involvement from leadership or other staff

Effectively communicate and collaborate in a team atmosphere to fulfill their responsibilities and meet deadlines utilizing excellent communication skills, prioritization, critical thinking, and data analysis skills

Support performance improvement and quality assurance initiatives

Participate in educational opportunities as provided by the hospital to enhance skill related abilities

Qualification

HFMA Certified Hospital Cost Report SpecialistMedicare Cost reportsHospital electronic health record systemsAdvanced Excel skillsFinancial analysisHealthcare reimbursement knowledgeMicrosoft Office SuiteCommunication skillsCritical thinkingProblem-solving abilitiesOrganizational skillsTime management skills

Required

Bachelor's Degree

HFMA Certified Hospital Cost Report Specialist (CHCRS)

Successful completion and submission of Medicare Cost reports for two or more (2+) years for Critical Access and/or Acute/IPPS facilities and successful navigation of at least two (2+) years of corresponding reviews, surveys, and audits (Interim rate reviews, S-10, Bad Debt, Charity Care, DSH, Wage Index, Occupational Mix, desk review, etc.)

Experience with hospital electronic health record systems (EPIC, Cerner, etc.), Cost Reporting applications, general ledger/accounting systems, and CMS/MAC cost reporting procedure, process, completion, submission, supporting schedules and documentation requirements, regulation, strategy, and audit

Advanced computer and spreadsheet skills, primarily in Excel

Extensive experience in financial analysis and interpretation of federal and state regulations

Specialized knowledge of hospital healthcare reimbursement, including but not limited to cost reporting, bad debt (including the reserve and posting process), S-10, Wage Index/Occupational Mix, DSH, 340b, and rate setting

Strong communication skills are necessary to interact effectively with management, staff and external auditors

Excellent analytical, critical thinking, and problem-solving abilities with the ability to manipulate and understand complex information and robust data sets and calculations

Effective organizational and time management skills with the proven ability to meet deadlines with precision, intention, and efficiency

Proficiency in Microsoft Office Suite (Excel, Access, Word, Outlook) and other fundamental computer skills

Ability to work effectively and independently managing tasks in a fast-paced environment

Preferred

Three (3) experience in healthcare accounting (general ledger, trial balance, income statement, balance sheet, cash flow, etc.), finance, revenue cycle, data analysis, and/or reimbursement