Government Reimbursement Analyst

Cost Report And Government Reimbursement Analyst

St. Charles Health System

Job Description

Title : Cost Report and Government Reimbursement Analyst

Reports To Position : Controller

Department : Accounting

Date Last Reviewed : March 18, 2021

Our Vision : Creating America's healthiest community, together

Our Mission : In the spirit of love and compassion, better health, better care, better value

Our Values : Accountability, Caring and Teamwork

Department Summary : The Accounting Department is responsible for maintaining accurate and timely financial records for the System, the hospital Foundation, and several Joint Ventures. The department facilitates an annual financial statement audit. The Department prepares and submits external financial reporting including, but not limited to, tax returns and cost reports. The Department is also responsible for internal reporting to support senior leadership in the decision-making process through the appropriate presentation of financial data. Not responsible for patient billing, collecting, account management or charity care assessments.

This role collaborates with the Payer Contracting and Revenue Cycle teams.

Position Overview : The Reimbursement Analyst is responsible for the preparation, coordination and management of the reimbursement-related regulatory filings for Medicare, Medicaid and other governmental or non-governmental agencies. In addition, the position is responsible for analyzing government program revenue streams and understanding financial impacts that arise from operational and programmatic changes.

This position does not directly manage other caregivers.

Essential Functions and Duties :

Responsible for the coordination of the preparation, filing, settlement and audit of the St. Charles cost reports and reimbursement-related regulatory filings for Medicare, Medicaid, other governmental or nongovernmental-agencies.

Prepares and / or reviews Medicare and Medicaid cost reports and other regulatory filings, and the related work papers in accordance with all applicable regulations and St. Charles polices.

Manages the production of compliant State and Federal cost reporting documents, including all annual cost reports, S-10 and wage index audits. Includes management of internal resources and external cost report experts.

Prepares and analyzes proposed audit adjustment impacts and submits additional documentation as required by the MAC or regulatory agency.

Reviews monthly workbooks and resultant journal entries to record third party settlements, and provider taxes payable and supplemental payments receivable. Assists the Accounting team in validating that workbooks stay current with regulatory changes.

Continuously monitors workload and methodologies used to achieve results, making recommendations to improve efficiency and / or cost savings whenever possible.

Ensures that all assigned statutory filings are timely and accurate.

Oversees the timely preparation, analysis, interpretation and distribution of government payer performance reports to divisional and financial leadership.

Analyzes the reimbursement impact of proposed new programs, payment models, services, and operating strategies. Provides reports and recommendations for achieving proposed financial objectives.

Accesses rate schedules, product details and historical claims to build and deploy model scenarios. Leverages multiple data points to provide visibility into all key model components.

Provides expertise to reimbursement strategies including review of methodology options and coordination of appeal opportunities in collaboration with Revenue Cycle leadership.

Supports the vision, mission and values of the organization in all respects.

Supports Value Improvement Practice (VIP- Lean) principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.

Provides and maintains a safe environment for caregivers, patients and guests.

Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies and procedures, supporting the organization's corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.

Delivers customer service and / or patient care in a manner that promotes goodwill, is timely, efficient and accurate.

May perform additional duties of similar complexity within the organization, as required or assigned.

Education :

Required : Bachelors degree in accounting or finance.

Preferred : N / A

Licensure / Certification / Registration :

Required : N / A

Preferred : Certified Public Accountant. Certified Healthcare Financial Professional.

Experience :

Required : Three (3) years of demonstrated experience in the healthcare finance or related field, including regulatory reporting.

Preferred : Previous work experience in consulting, in a multi-hospital system, health insurer, or MAC.

Personal Protective Equipment :

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

Physical Requirements :

Continually (75% or more) : Use of clear and audible speaking voice and the ability to hear normal speech level.

Frequently (50%) : Sitting, standing, walking, lifting 1-10 pounds, keyboard operation.

Occasionally (25%) : Bending, climbing stairs, reaching overhead, carrying / pushing or pulling 1-10 pounds, grasping / squeezing.

Rarely (10%) : Stooping / kneeling / crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle.

Never (0%) : Climbing ladder / step-stool, lifting / carrying / pushing or pulling 25-50 pounds, ability to hear whispered speech level.

Exposure to Elemental Factors :

Never (0%) : Heat, cold, wet / slippery area, noise, dust, vibration, chemical solution, uneven surface.

Blood-Borne Pathogen (BBP) Exposure Category :

No Risk for Exposure to BBP