Associate Reimbursement Analyst- Regulatory, Reporting, and Audit

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The primary focus of this position is for the candidate to develop a broad knowledge of healthcare reimbursement topics and regulations in a learning environment and apply the information learned through various projects (including but not limited to Medicare Cost Reports, State cost reports, DSH Surveys and Audits, medical education relating to IME and GME reimbursement, bads debt, charity care, S-10, Wage Index, Occupational Mix, DSH, Nursing and Allied Health, etc.). The candidate will work in a team atmosphere to design reports and analyze data from various sources in order to prepare supporting work papers and reports as required by regulatory agencies. Excellent communication skills are imperative to coordinate information from various levels of the organization, Medicare and Medicaid auditors, external vendors, state and federal agencies, etc. This position is entry level and will work toward a goal of gaining extensive knowledge of third party reimbursement regulations and use critical thinking, analysis skills, and problem-solving skills to promptly, accurately, and effectively address issues, questions, complete projects, create, update, correct, analyze, and submit required submissions and supporting documentation, meet deadlines, etc. without direct leadership or other staff involvement. Must be able to operate independently in highly efficient and effective manner and replicate prior year workpapers, support, documentation, etc.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree.

EXPERIENCE:

1.  Three (3) years of data analysis and regulatory reporting, financial statement analysis. general ledger, and/or variance analysis.

2.  Advanced computer and spreadsheet skills, primarily in Excel.

 

PREFERRED QUALIFICATIONS:

1. Experience in a healthcare or health system environment preferably in reimbursement, finance, and/or accounting.

2.  Three (3) years of data analysis and regulatory reporting, financial statement analysis. general ledger, and variance analysis.

   

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Assists with and prepares all third party cost reports (Medicare, WV Medicaid, PA Medicaid, Ohio Medicaid, Champus/Tricare, etc.) and amends as necessary any cost report as needed. Assists with the audits 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).

2. Conducts research and provides documentation and explanations in response to auditor’s inquires, analyzes calculations, supporting workpapers, source data/documentation, etc., and interprets justifications substantiating cost report submissions during all types and phase of audits, cost report re-openings of previously audited cost reports, appeals of disputed issues after audits are finalized, etc. Provides updates on status and monetary impact of all settlements, amendments, audits, etc. and regularly tracks, updates, and communicates with necessary parties regarding any and all reimbursement items.

3. Coordinates gathering all data required for completion of cost reports from various departments systems and external sources.

4. Conducts research and provides documentation and explanations for all necessary workpapers, schedules, and forms and updates workpapers, Absolute, and HFS systems/files promptly and accurately.

5. Designs and completes weekly, monthly and annual reports used for monthly financial statements, annual Medicare Cost Reports, HCA Uniform Reports, the annual budget and external audits and/or as needed.

6. Analyzes data from all sources to ensure accuracy and consistency.

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

8. Assists with and prepares the Uniform Report (or other mandated reporting) for the WV Healthcare Authority (and other applicable governmental bodies, departments, agencies, etc.)  annually and as required.

9. Complete Interim rate request forms and conducts analysis of all rate changes including estimated impact and identification of potential risk and/or opportunity. Responsible for distributing updated rates and estimated impact to internal departments.

10. Maintain and continually improve on technical skills needed to manipulate data.

11. Develop database report writing skills in Strata and other systems as needed.

12. Maintains all third-party cost report computer software systems, including installing all updates.

13. Compiles all data for the Medicaid DSH Survey and DSH audit annually.

14. Prepares and analyzes data and compiles supporting documentation for Wage Index submissions and reviews and Occupational Mix surveys to support the reimbursement team and identify specific areas for risk and/or opportunity. Assists in answering questions during the review of these items, providing supporting documentation and rationale, analyzing proposed adjustments, and other support as needed.

15. Provides necessary data and support to the reimbursement team to calculate third party receivables and payables as needed but at least monthly.

16. 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.

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

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

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

20. Participates in performance improvement through planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, committees, task forces, cross functional groups, projects and discussion with hospital management and staff.

21. 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.

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

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, lifting, grasping and feeling are necessary body movements utilized in performing duties through the work shift.

2. Must be able to sit for extended periods of time.

3. Must be able to read and write legibly in English.

4. Visual acuity must be within normal range.

5. Must have hearing abilities in order to communicate effectively via telephone and in person.

6. Must have reading and comprehensive ability.

 

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office type environment.

2. Ability to work remotely.

 

SKILLS AND ABILITIES:

 

1. Direct experience in financial analysis and interpretation of federal and state regulations.

2. Specialized knowledge of hospital healthcare reimbursement.

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

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

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

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

7. Ability to work effectively and independently managing tasks in a fast-paced environment and replicate prior period workpapers, analysis, documentation, support, etc.

8. Advanced computer and spreadsheet skills, primarily in Excel.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Day (United States of America)

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

540 SYSTEM Finance and Reimbursement