Reimbursement Specialist, Financial Services, 1.0FTE, Day Shift - FSS (*****)

Company Name:
St. Vincent Infirmary Medical Center
Title: Reimbursement Specialist, Financial Services, 1.0FTE, Day Shift - FSS ( )
Location: WA-Tacoma
Other Locations:
This job is responsible for researching, preparing and filing annual cost reports for assigned facilities as mandated by the Centers for Medicare and Medical Services (CMS) for Medicare-certified institutional providers and in accordance with applicable regulatory guidelines. An incumbent assures a formal cost report preparation process is in place, and is responsible for ensuring that deadlines are met and documentation is continually maintained with respect to Medicare cost report reserves and estimated settlement amounts during the preparation process.
Work also includes: 1) researching audit findings and preparing appeal documents; 2) consulting with management on strategies/requirements in order to maximize reimbursement potential and ensure regulatory compliance; 3) preparing reimbursement analyses, focused on maximizing allowable reimbursement; and 4) serving as the contact for external audits for assigned facilities. An incumbent also is a key participant in the month-end accounts receivable reserving process, and is responsible for analyzing, reconciling, and reporting on contractual, bad debt, and charity allowances.
This job requires considerable knowledge of the Medicare appeals process from a provider perspective, and involves the analysis/interpretation of dynamic and complex CMS regulations in order to ensure compliance and realization of maximum reimbursement. Work is conducted independently, and an incumbent exercises considerable discretion and independent judgment in identifying compliance issues, addressing reimbursement concerns and working with managers to develop and implement effective solutions to mitigate or resolve them.
The following section contains representative examples of job duties that might be performed in positions allocated to this job class. FHS is a dynamic organization, and the environment can be fluid. Roles and responsibilities may be altered to accommodate changing business conditions and objectives as well as to tap into the skills and experience of its employees. Accordingly, employees may be asked to perform duties that are outside the specific work that is listed. It is not required that any position perform all duties listed, so long as primary responsibilities are consistent with the work as described. Performance standards developed for incumbents allocated to this job class may also contain relevant job content information and are referenced hereto.
Prepares and files (electronically) the annual Medical Cost Report (MCR) for the assigned facilities in support of claims for overall reimbursement; understands and interprets CMS guidelines to ensure report(s) are completed and submitted in compliance with CMS standards and guidelines.
Gathers and reviews claims/reimbursement data/reports on a monthly basis from facility managers in accordance with established procedures; follows up with managers as necessary to clarify data and/or gather additional information.
Processes facility financial and statistical data through electronic systems to prepare schedules required for cost report preparation.
Reconciles key financial data such as total expenses, total patient revenue, Medicare and Medicaid program revenue, etc., to source data (e.g., G/L, PS&R).
Documents and explains material variations in the supporting cost reporting work papers.
Maintains cost report inventory that includes status and deadlines.
Maintains schedule of Medicare cost report reserves and estimated settlement amounts; analyzes reserve data and prepares spreadsheets to communicate issues/cost impacts to management.
Performs an analysis of key Medicare and Medicaid reimbursement areas to identify potential prospective and retrospective reimbursement opportunities.
Maintains schedule of Medicare cost report reserves and estimated settlement amounts.
Identifies inadequate reserves and/or settlement estimates, and discusses with manager.
Serves as the internal contact (for assigned facilities) for federal agencies or external parties conducting Medicare audits; provides auditors access to information and records as requested, in a timely manner.
Coordinates auditor requests with all internal departments.
Communicates reimbursement information and responds to questions, inquiries, and requests.
Assists with the implementation of programmatic changes to help drive the organization's compliance.
Reviews and evaluates CMS fiscal intermediary audit adjustment reports relative to submitted cost reports for assigned facilities; researches and evaluates the merits of disputed reimbursements and files Medicare appeals to recover payment consistent with established guidelines.
Identifies strengths and weaknesses of audit findings.
Interacts directly with fiscal intermediary auditors to discuss findings, interpretations, guidelines and troubleshoot issues; prepares formal appeals as appropriate and follows up to facilitate appropriate resolution. discusses contract interpretation to support request for additional reimbursement.
Maintains documentation relating to all reimbursement issues and report follow-up activities.
Follows up on pending reimbursement issues relating cost reports filed in previous years.
Keeps manager abreast of significant financial impact of disallowed reimbursement payments.
Education/Work Experience Requirements:
Bachelor's degree in Finance, Accounting, Business Administration or related field that demonstrates attainment of the requisite job knowledge skills/abilities, and four years of progressively responsible related work experience, preferably in a healthcare setting.
Or any equivalent combination of education and experience which would demonstrate the required knowledge, skills and abilities to perform the essential functions of the position.
Additional Responsibilities:
Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
Adheres to and exhibits our core values:
Reverence:Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
Integrity:Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
Compassion:Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
Excellence:Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
Maintains confidentiality and protects sensitive data at all times.
Adheres to organizational and department specific safety standards and guidelines.
Works collaboratively and supports efforts of team members.
Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers.CB

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