Reimbursement Analyst - Senior

Job Title: Reimbursement Analyst - Senior

Department: Reimbursement Specialist - Finance

Location: Riedman Campus

SUMMARY:

Provide and maintain Hospital reimbursement expertise as it relates to Medicare, Blue Cross and Medicaid. Prepare annual institutional cost report, physician questionnaire and other third party information requests as necessary. Calculate and record hospital inpatient and outpatient revenues on a monthly basis.

RESPONSIBILITIES:

Provide and maintain Hospital reimbursement expertise as it relates to Medicare, Blue Cross and Medicaid (as observed by Asst. Controller and Controller).

Studies and comprehends reimbursement regulations and attends reimbursement seminars to maintain knowledge of reimbursement regulations and current issues.

Trains and educates accounting department and other hospital employees in the technical aspects of reimbursement.

Relates reimbursement knowledge to Hospital operations and makes recommendations on how to maximize reimbursement. Identifies appeal able items which could enhance reimbursement. Prepares and submits appeals.

Accurately prepares and submits on a timely basis the annual institutional cost report, physician questionnaire and other third party information requests in compliance with applicable instructions (as observed by Asst. Controller, Controller and supported by third party payor audits).

Coordinates third party pay or field audits responding to all audit inquiries and investigating all audit findings. Makes recommendations as to whether the third party audit findings are in compliance with reimbursement regulations.

Accurately calculate and record hospital inpatient and outpatient revenues on a monthly basis.

Accurately calculate net patient service revenue (inpatient and outpatient) on a monthly basis for inclusion in the monthly financial statements within 1% of total revenue.

Maintains revenue files on computer system which enable calculation of revenue per DRG. Data is used for Management informational purposes.

Ensures rates used in issuing patient bills are the most recent certified and approved rates by regulatory agencies.

REQUIRED QUALIFICATIONS:

BA in Accounting or Business, with prior reimbursement experience or an equivalent combination of education and work experience.

3 to 5 years of prior reimbursement experience with demonstrated progressive levels of responsibility

Strong analytical, computer, and communication skills

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:$70,000.00 - $90,000.00

CITY:Rochester

POSTAL CODE:14617

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer.

Minority/Female/Disability/Veterans by a prospective employee and/or employee’s Physician or delegate will be considered for accommodations.

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