Senior Reimbursement Analyst- Regulatory and Reporting

Accountabilities:

Prepare, review, advise on, and submit third-party reimbursement cost reports and regulatory filings, including Medicare, West Virginia Medicaid, Pennsylvania Medicaid, Ohio Medicaid, and CHAMPUS/TRICARE reports.
Coordinate the collection and consolidation of financial and operational data from internal departments, information systems, and external sources to ensure accurate and timely regulatory submissions.
Monitor filing deadlines, amendments, settlements, audits, adjustments, and reimbursement-related developments, communicating their progress and financial impact to relevant stakeholders.
Conduct regulatory research and prepare supporting documentation, workpapers, schedules, forms, and explanations required for reimbursement filings and audits.
Analyze reimbursement regulations, legislation, and policy changes to assess their financial implications and identify opportunities to improve reimbursement outcomes.
Perform detailed data validation and technical reviews to ensure consistency, accuracy, and compliance with applicable regulatory requirements and audit standards.
Develop and maintain reimbursement budget models using current, proposed, and finalized regulations to support financial planning and forecasting.
Prepare the annual Uniform Report for the relevant state healthcare authority and support other required regulatory reporting activities.
Evaluate current reimbursement rate structures and forecast future financial impacts based on cost report submissions and applicable reimbursement factors.
Collaborate with internal audit teams to assess the impact of reviews, audits, reimbursement settlements, and rate adjustments.
Prepare and submit annual Medicaid Disproportionate Share Hospital (DSH) surveys and support related audits, identifying reimbursement opportunities, potential risks, and process improvements.
Compile and maintain supporting documentation for Wage Index, Occupational Mix, transplant, Nursing and Allied Health, Bad Debt, Charity Care, S-10, desk reviews, IME/GME overlap, and time studies or allocation reports.
Support regulatory reviews and audits by responding to inquiries, providing supporting documentation, researching invoices, validating data, and ensuring compliance with required templates and reporting standards.
Provide analytical data and supporting information to the reimbursement team for the calculation of third-party receivables and payables.
Deliver financial analysis, regulatory interpretations, and supporting documentation for annual financial audits and governmental audits.
Coordinate reimbursement-related projects with external consultants and internal stakeholders according to departmental priorities.
Develop and enhance technical reporting capabilities, including database reporting and data analysis using Strata and other relevant systems.
Review existing reporting structures and workflows to identify opportunities to improve accuracy, efficiency, consistency, and automation.
Maintain and replicate historical workpapers, supporting schedules, and documentation while ensuring continuity and accuracy across reporting periods.
Identify and resolve reimbursement-related issues promptly to prevent financial losses, maximize reimbursement opportunities, and meet regulatory deadlines.
Contribute to departmental objectives, teamwork, quality assurance, and continuous improvement initiatives while supporting colleagues and sharing technical expertise.
Participate in relevant educational and professional development opportunities to maintain and strengthen technical and regulatory knowledge.
Requirements:
Bachelor's degree required, or certification as a Healthcare Financial Management Association (HFMA) Certified Hospital Cost Report Specialist (CHCRS).
At least 3 years of experience successfully preparing and submitting Medicare Cost Reports for Critical Access Hospitals and/or Acute Care/Inpatient Prospective Payment System (IPPS) facilities.
At least 3 years of experience with hospital electronic health record systems such as EPIC or Cerner, cost reporting applications, general ledger and accounting systems, or CMS/MAC cost reporting processes, including preparation, submission, supporting documentation, regulatory requirements, and audit procedures.
At least 2 years of experience using advanced computer applications and spreadsheet tools, particularly Microsoft Excel.
Three or more years of experience in healthcare accounting, finance, revenue cycle management, data analysis, and/or reimbursement is preferred.
At least 2 years of experience successfully managing corresponding regulatory reviews, surveys, and audits, such as interim rate reviews, S-10, Bad Debt, Charity Care, DSH, Wage Index, Occupational Mix, and desk reviews, is preferred.
Extensive knowledge of healthcare reimbursement methodologies and federal and state regulations, particularly Medicare and Medicaid cost reporting requirements.
Specialized understanding of hospital reimbursement processes, including Bad Debt reserves and posting, S-10 reporting, Wage Index, Occupational Mix, DSH, 340B, and reimbursement rate setting.
Strong financial analysis and interpretation skills, with the ability to evaluate complex regulatory information, financial statements, accounting records, and reimbursement calculations.
Advanced analytical, critical-thinking, and problem-solving abilities, including experience manipulating large datasets and developing financial models and reporting solutions.
Proficiency in Microsoft Office applications, particularly Excel, Access, Word, and Outlook, along with strong general computer skills.
Experience with Strata, cost reporting applications, healthcare financial systems, and database reporting tools is an advantage.
Excellent written and verbal communication skills, with the ability to explain complex financial and regulatory matters to management, colleagues, auditors, and external consultants.
Strong organizational and time management skills, with the ability to manage multiple projects, prioritize competing deadlines, and deliver accurate work efficiently.
Demonstrated ability to work independently, exercise sound judgment, and resolve complex issues without requiring continuous supervision.
Strong collaboration and interpersonal skills, with a proactive approach to teamwork, knowledge sharing, and continuous process improvement.
Ability to adapt to changing regulations, reporting requirements, and operational priorities while maintaining accuracy and compliance.
Ability to work in a remote office environment, including extended periods of computer-based work and effective communication through digital and telephone channels.
Benefits:
Full-time remote working arrangement within the United States.
40-hour workweek.
Opportunity to work on complex healthcare reimbursement, financial reporting, and regulatory compliance projects.
Exposure to Medicare, Medicaid, and multiple state and federal reimbursement programs.
Opportunities to develop specialized expertise in healthcare finance, cost reporting, reimbursement strategies, and regulatory analysis.
Professional development through ongoing education, technical training, and exposure to evolving regulatory requirements.
Collaborative working environment involving finance, reimbursement, audit, and healthcare operations professionals.
Opportunities to contribute to strategic financial initiatives, process improvements, and reimbursement optimization.
Salary, healthcare coverage, retirement benefits, paid time off, and additional employee perks were not specified in the original job posting and should be confirmed with the hiring team.