Senior Medicaid & Medicare Reimbursement Consultant

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Job Description Summary :

This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities.

• This position will be responsible for ensuring the appropriate governmental (Medicare and Medicaid) reimbursement is received for OhioHealth.
• This position is primarily responsible for the proactive calculations and modeling of new regulatory changes and impacts as well as variance analysis of third-party liability accounts. Provides supporting work papers and documentation for third-party inquires.
• This position has supervisory oversight of the Reimbursement Analyst daily work schedule including flow of information, teaching of reimbursement fundamentals and principals, review of work and setting daily priorities.
• This positon supports the Director of Revenue and Reimbursement and Manager of Reimbursement with many special analysis throughout the year associated with revenue cycle, charge analysis, regulatory and financial reporting.
• The Senior Reimbursement Consultant will be a subject matter expert in the following areas, S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, Indirect Medical Education, Graduate Medical Education, and Governmental Logs, (HCAP, UPL and Franchise Fee programs in the state of Ohio) as well as special projects as assigned.
• Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement and remaining up to date with all regulatory requirements, both federal and state is required.
• The Reimbursement Consultant position leads, advises and consults various reimbursement financial projects, as well as special projects throughout the year and needs to be able to delegate direct reports assigned to the project or process while staying connected to both the pertinent details as well as the high level strategic purpose.
• The Senior Reimbursement Consultant is required to use extensive interpersonal skills in communicating with all management levels at OhioHealth.
• This role functions in a heavily matrixed environment and requires strong prioritization, communication and planning skills.

Responsibilities And Duties :

Consulting and oversite of key areas at OhioHealth in the central Ohio facilities as well as non-central Ohio facilities in the reimbursement functions.

Knowledge in the following areas :

Reimbursement functions :

Subject matter expert on CMS cost reporting, disproportionate share (DSH), Uncompensated Care,  Bad debt reporting, IME / GME, Medicare Wage Index, S-10 reporting, Tricare and 855’s, Ohio Medicaid, HCAP, UPL and Franchise Fee programs. Knowledge of Acute Care Hospitals, Critical Access Hospitals, Sole Community Hospitals and Rural Health Clinics. Knowledge of reimbursement in specialty areas such psych, inpatient rehabilitation units, Home Health and Hospice.   Projects as assigned by Director of Revenue and Reimbursement and Manager of Reimbursement. Provide Director of Revenue and Reimbursement and Manager with updates. CGS audits and auditors Working with our legal vendor for Medicare Appeals. Working with OHA and CBSA facilities on wage index opportunities Special projects / analysis as assigned by the Director of Revenue and Reimbursement and Manager of Reimbursement.

Minimum Qualifications :

Bachelor's Degree : Finance (Required)

Additional Job Description :

BS or BA in Accounting or Finance. Hospital and / or healthcare industry experience. Understanding of the CMS prospective payment system and State of Ohio regulations. Minimum of 4 years’ experience in the healthcare industry. Strong team development and delegations skills. Excellent communication and presentation skills.

SPECIALIZED KNOWLEDGE

Min : Proficiency in Microsoft applications, knowledge of clinical & financial patient management systems, demonstrated ability in financial analysis and cost reporting.

DESIRED ATTRIBUTES

CPA, MHA or MBA. Experience with Medicare / Medicaid cost reporting 4 - 6 years as a Sr. Reimbursement Analyst or similar position(s).

Work Shift : Day

Scheduled Weekly Hours :

40

Department

Reimbursement

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Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

Remote Work Disclaimer :

Positions marked as remote are only eligible for work from Ohio .