OverviewDescriptionJ
ob Summary:- Serves as a senior technical subject matter expert responsible for the independent preparation, coordination, and optimization of Medicare, Medicaid, Tricare, and other governmental cost reports and regulatory filings across the health system.
- Owns end-to-end cost report production for assigned entities - including data collection, workpaper development, settlement modeling, and filing coordination - while interpreting and applying CMS and State Medicaid regulations to ensure compliant, optimized reimbursement outcomes.
- Serves as a key liaison with Decision Support, General Accounting, Patient Financial Services, Case Management, and GME to validate data integrity and ensure accurate reporting.
- Monitors MAC correspondence, settlement notices, and regulatory communications.
- Supports reimbursement forecasting and reserve development through settlement modeling, interim rate analysis, and pass-through payment validation.
Primary duties and responsibilities:Cost Report Preparation & Filing- Prepare Medicare, Medicaid, and Tricare cost reports for assigned entities, managing the full cycle from data collection and workpaper development through filing coordination.
- Interpret and apply CMS and State Medicaid regulations to ensure compliant reporting and identify reimbursement optimization opportunities.
- Support Wage Index and Occupational Mix survey preparation and filing.
Settlement Component Analysis- Lead preparation and analysis of complex settlement components including Medicare bad debt, DSH, S-10 uncompensated care, IME/GME, organ acquisition, ESRD, transplant, and other pass-through or supplemental payment programs.
- Validate pass-through payments and lump sum adjustments; reconcile interim rates against settled amounts.
Audit, Appeals & Regulatory Defense- Coordinate supporting documentation and audit trails required for desk reviews, audits, and appeals.
- Monitor MAC correspondence, settlement notices, and regulatory communications; coordinate responses and required documentation.
- Support audit strategy development and defend filed positions through the appeals process.
Forecasting & Financial Close- Prepare monthly third-party settlement model supporting month-end close and reserve reporting.
- Support reimbursement forecasting and reserve development through settlement outcome modeling and interim rate change analysis.
Data Validation & Stakeholder Collaboration- Partner with Decision Support, General Accounting, PFS, Case Management, and GME to validate data integrity and ensure accurate reimbursement reporting.
- Identify and resolve data discrepancies impacting cost report accuracy or settlement outcomes.
- Additional Duties as Assigned.
Travel:- Less than 10% of the time may be required.
Work Type:Minimum Required Qualifications:Education- Bachelor's degree in Accounting, Finance, or Business.
Experience - 5 years minimum experience in accounting/finance with 3 years in reimbursement or cost reporting
Knowledge, skills, and abilities (required):
- Working knowledge of hospital patient accounting, general ledger, and decision support systems (Epic, Strata, or equivalent)
- Knowledge of pass-through payment structures, lump sum adjustments, and interim rate reconciliation
- Organ Acquisition, 340B, and IRIS experience preferred
- Ability to communicate complex reimbursement concepts clearly to finance, clinical, and operational stakeholders
- Experience interfacing with MACs, CMS, and state agencies during audits, desk reviews, and appeals
- Comfortable managing multiple filing deadlines and regulatory timelines simultaneously
Preferred QualificationsEducation- Master's Degree in finance or accounting
Experience- 7 years minimum experience with at least 5 years in reimbursement or cost reporting
PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, frequent sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.
ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.
Additional Details 
