Reimbursement Specialist

Description Hackensack Meridian Health (HMH) is seeking a Reimbursement Specialist III to provide senior‑level technical and analytical support for all reimbursement functions across the HMH Network. The role involves complex work in Medicare, Medicaid, and state reimbursement, including preparation of cost reports, advanced analyses, audits and appeals. Responsibilities Keep fully informed of current and anticipated changes in Medicare and Medicaid reimbursement and assess impact on the Network’s entities. Summarize final regulations with applicable financial impacts and distribute to key internal stakeholders. Prepare written comments on proposed regulatory changes and submit them to CMS and Medicaid. Organize and coordinate potential revenue‑enhancement opportunities, including combining provider numbers, wage index, disproportionate share, charity care subsidy, medical education, organ transplantation, and Medicare bad debts. Research and file governmental appeals, track and report status. Support coordination and filing of the Corporate Cost Report. Prepare Medicare, Chapter 160 and Champus cost reports for hospitals, including advanced worksheets. Coordinate and accumulate information for Home Health Agency and Home Office cost reports. Collect and prepare statistical data as required, including interns and residents schedules and IRIS preparation. Support Wage Index submission to CMS and act as point person for Wage Index audits. Complete NJ DSH and Occupational Mix surveys. Coordinate bad debt audits with Patient Accounting. Support Medicare and Medicaid appeals with necessary documentation and timely submission. Research, coordinate and complete CMS and Molina applications such as 855s and IME/GME Resident Cap Increase applications. Assist in ensuring Medicare and Medicaid rates are correctly reported in the system. Complete Psychiatry PPS exclusion analysis. Conduct internet and publication research to ensure compliance and maximize reimbursement strategies within regulations. Coordinate and support Medicare and Medicaid audits, acting as audit point person. Review audit adjustments and communicate with external auditors to resolve issues. Input cost‑report data using software as needed. Perform monthly review of third‑party accounts of HMH hospitals. Execute special projects and other duties assigned by Management. Adhere to HMH organizational competencies and standards of behavior. Qualifications Bachelor’s degree in Accounting, Finance or related field. Minimum of five years progressive reimbursement experience in consulting and/or a large health network or academic medical center. Advanced proficiency with Microsoft Office (Excel, Outlook, etc.). Proven record of progressive professional growth and responsibility. Excellent written and verbal communication skills. Excellent analytical skills, including ability to complete detailed work papers for an audit trail. Ability to establish effective working relationships with all levels of the HMH organization. Preferred Licenses and Certifications Certified Public Accountant (CPA) and/or Master of Business Administration (MBA). Governmental audit experience. Compensation & Benefits Starting pay is a minimum of $45.94 per hour, benchmarked against market data and based on experience, education, and role requirements. HMH offers a comprehensive benefits package that includes health, dental, vision, paid leave, tuition reimbursement, and retirement benefits. #J-18808-Ljbffr