Senior Financial Government Reimbursement Analyst

Overview

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• And more

Description

J ob Summary:

• Serves as a senior technical subject matter expert responsible for the independent preparation, coordination, and optimization of Medicare, Medicaid, Tricare, and other governmental cost reports and regulatory filings across the health system.

• Owns end-to-end cost report production for assigned entities - including data collection, workpaper development, settlement modeling, and filing coordination - while interpreting and applying CMS and State Medicaid regulations to ensure compliant, optimized reimbursement outcomes.

• Serves as a key liaison with Decision Support, General Accounting, Patient Financial Services, Case Management, and GME to validate data integrity and ensure accurate reporting.

• Monitors MAC correspondence, settlement notices, and regulatory communications.

• Supports reimbursement forecasting and reserve development through settlement modeling, interim rate analysis, and pass-through payment validation.

Primary duties and responsibilities:

Cost Report Preparation & Filing

• Prepare Medicare, Medicaid, and Tricare cost reports for assigned entities, managing the full cycle from data collection and workpaper development through filing coordination.

• Interpret and apply CMS and State Medicaid regulations to ensure compliant reporting and identify reimbursement optimization opportunities.

• Support Wage Index and Occupational Mix survey preparation and filing.

Settlement Component Analysis

• Lead preparation and analysis of complex settlement components including Medicare bad debt, DSH, S-10 uncompensated care, IME/GME, organ acquisition, ESRD, transplant, and other pass-through or supplemental payment programs.

• Validate pass-through payments and lump sum adjustments; reconcile interim rates against settled amounts.

Audit, Appeals & Regulatory Defense

• Coordinate supporting documentation and audit trails required for desk reviews, audits, and appeals.

• Monitor MAC correspondence, settlement notices, and regulatory communications; coordinate responses and required documentation.

• Support audit strategy development and defend filed positions through the appeals process.

Forecasting & Financial Close

• Prepare monthly third-party settlement model supporting month-end close and reserve reporting.

• Support reimbursement forecasting and reserve development through settlement outcome modeling and interim rate change analysis.

Data Validation & Stakeholder Collaboration

• Partner with Decision Support, General Accounting, PFS, Case Management, and GME to validate data integrity and ensure accurate reimbursement reporting.

• Identify and resolve data discrepancies impacting cost report accuracy or settlement outcomes.

• Additional Duties as Assigned.

Travel:

• Less than 10% of the time may be required.

Work Type:

• Remote employee

Minimum Required Qualifications:

Education

• Bachelor's degree in Accounting, Finance, or Business.

Experience

• 5 years minimum experience in accounting/finance with 3 years in reimbursement or cost reporting

Knowledge, skills, and abilities (required) :

• Working knowledge of hospital patient accounting, general ledger, and decision support systems (Epic, Strata, or equivalent)

• Knowledge of pass-through payment structures, lump sum adjustments, and interim rate reconciliation

• Organ Acquisition, 340B, and IRIS experience preferred

• Ability to communicate complex reimbursement concepts clearly to finance, clinical, and operational stakeholders

• Experience interfacing with MACs, CMS, and state agencies during audits, desk reviews, and appeals

• Comfortable managing multiple filing deadlines and regulatory timelines simultaneously

Preferred Qualifications

Education

• Master's Degree in finance or accounting

Experience

• 7 years minimum experience with at least 5 years in reimbursement or cost reporting

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, frequent sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at View email address on click.appcast.io . Please note that one week's advance notice is preferred.

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Division Emory Healthcare Inc.

Campus Location Atlanta, GA, 30345

Campus Location US-GA-Atlanta

Department EHI Hospitals Finance

Job Type Regular Full-Time

Job Number 164663

Job Category Revenue Cycle & Managed Care

Schedule 8a-5p

Standard Hours 40 Hours

Hourly Minimum USD $41.28/Hr.

Hourly Midpoint USD $50.30/Hr.

Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.