Reimbursement Specialist

Senior Reimbursement Specialist

Location: Albany GA

Responsible for all reimbursement issues and reporting any changes in reimbursement regulations. Preparing supporting documentation and worksheets to support the preparation and completion of the Medicare and Medicaid Cost Reports. Analyzing and responding to Medicare/Medicaid inquiries or audits. Staying abreast of current Medicare/Medicaid regulation changes and incorporating those into the Cost Reporting. Providing assistance to related departments regarding related issues. Preparing provider-based applications and any other necessary changes related to provider enrollment for the hospitals in the system.

Education Requirements:

• 4 year / Bachelor's Degree (Required)
• Master's Degree (Preferred)

Experience Requirements:

• 5 - 6 Years hospital rehabilitation (Required)
• 5 - 6 Years hospital cost report preparation (Required)

Certifications and Licensures:

• Preferred Certifications/Licensures: Certified Public Accountant (CPA)

Essential Functions:

• Understands and ensures organizational compliance with all ICTF DSH 340b rules and regulations while maximizing organizational revenue from these programs.
• Takes the lead role in coordinating the entire ICTF process.
• Determines ICTF intergovernmental transfer amount and coordinates appropriate filings for receipt of funds.
• Prepares annual hospital financial survey.
• Utilizes knowledge base in regulatory reimbursement/accounting to analyze and develop financial data for profitability studies budgeted deductions and other data analysis.
• Accurately and timely completes requests for reimbursement information from both internal and external customers.
• Works with individual departments to maximize Medicare/Medicaid reimbursement.
• Accurately computes and analyzes budgeted deductions from revenue.
• Completes month-end and year-end reimbursement journal entries.
• Provides assistance in analyzing managed care contracts.
• Completes and files government payor provider applications.
• Ensures all cost reports (Medicare Medicaid Tri-Care et al) are completed accurately and that corresponding revenue is maximized from both a reporting and programmatic perspective.
• Coordinates cost reporting for Hospitals under the Health System and serves as a resource for rural hospitals.
• Directs preparation of documentation for cost report during audit.
• Keeps knowledge current on all Medicare and Medicaid regulations and identifies.

Additional Duties:

• Adheres to the hospital and departmental attendance and punctuality guidelines.
• Performs all job responsibilities in alignment with the core values mission and vision of the organization.
• Performs other duties as required and completes all job functions as per departmental policies and procedures.
• Maintains current knowledge in present areas of responsibility (i.e. self-education attends ongoing educational programs).
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
• Demonstrates competency at all levels in providing care to all patients based on age sex weight and demonstrated needs.
• For non-clinical areas has attended training and demonstrates usage of age-specific customer service skills.