Summary:
The Senior Reimbursement Analyst serves as the principal technical resource and primary backup to the Reimbursement Director, with lead accountability for Medicare and Medicaid cost report preparation, submission, and audit defense across the enterprise. This position determines net revenue and third-party settlement positions recorded on the audited financial statements, quantifies the financial impact of federal and state regulatory change, and provides technical direction to reimbursement analysts. Decisions made in this role directly affect multi-million-dollar governmental reimbursement for the organization, reserve adequacy, and the health system's exposure in federal and state audits.
Responsibilities:
1. Independently prepares, reviews, and supports submission of Medicare, Medicaid, Tricare, and other governmental cost reports in compliance with all regulatory requirements through final settlement, reopening, and appeal.
2. Holds primary accountability for monthly and annual net revenue and third-party contractual reserves recorded in the audited financial statements; serves as the principal departmental contact to external auditors on these balances.
3. Serves as the Director's designated backup and second reviewer for filings and settlement positions; represents the department to Finance leadership in the Director's absence.
4. Collaborates with external auditors, consultants, and regulatory agencies to ensure compliance and resolve audit findings.
5. Independently models the financial impact of proposed and final CMS rules (IPPS, OPPS, wage index, DSH) and Ohio Medicaid changes, translating regulatory language into quantified dollar impact for Finance leadership. Prepares written analysis and recommendations for executive review.
6. Involved with all CHGME applications, reconciliation, and reporting cycles, including FTE resident counts and direct and indirect expense allocations.
7. Serves as the lead analyst for HCAP, UPL, Franchise Fee, directed payment, and enhanced reimbursement filings; models eligibility and optimizes system positioning across programs.
8. Involved with preparation of IRS Form 990 Schedule H and the Children's Community Benefit Report in close partnership with External Affairs.
9. Maintains current knowledge of Medicaid and CMS attestation requirements and coordinates MPIP submissions.
Other information:
Technical Expertise- Demonstrated experience in audits, settlement negotiation, reopening, or appeal with a state agency required.
- Demonstrated experience with net revenue calculation and third-party reserve analysis within a month-end close required.
- Working knowledge of Ohio-specific programs (HCAP, UPL, Franchise Fee, directed payments) required.
- Advanced Excel (complex modeling, large data sets, pivot and lookup architecture) required.
- Proven ability to communicate technical reimbursement conclusions to management required.
- ERP (Workday), EHR (Epic), and decision support or reimbursement platforms preferred.
- CHGME reporting experience preferred.
• Excellent analytical, organizational, and project management skills.
Education and Experience
1. Education: Bachelor's degree in Accounting, Finance, or Healthcare Administration required; Master's degree or CPA strongly preferred.
2. Licensure: NA
3. Certification: NA
4. Years of relevant experience: Minimum of 7 years of experience in healthcare cost reporting or reimbursement analysis. Five (5) or more years of progressive Medicare/Medicaid cost report experience, including independent, end-to-end responsibility for a full cost report filing required.
5. Years of supervisory experience: NA
Full Time
FTE: 1.000000
Status: Fixed Hybrid
