Kent Campus Hospital

STATUS: Full Time 80 Hours

SHIFT: Days

GENERAL SUMMARY:

Summary:

The Reimbursement Analyst tracks and audits Medicare reimbursement. This position also prepares the annual Tricare capital and residency report and prepares the Medicare Cost Report for the two hospital and the home office for the review by the Senior Manager of Reimbursement. This position also performs additional reimbursement analysis functions like (DSH, GME, IME, S-10, Bad Debt & Wage Index).

ESSENTIAL FUNCTIONS & ACCOUNTABILITIES:

1. Medicare Cost Report File Medicare Cost Report by filing deadline of November 30. Person should be diligent in preparation of the cost report to ensure compliance with all the Medicare regulations and accuracy to maximize reimbursement and minimize the effect of any audit adjustments by Medicare auditors. a) A-8-2 Physician compensation- Ensure that Part A administration expenses is separated from Part B patient related expense. In addition, this position loads complex time-consuming worksheet to support Medicare filing and sends out letters to provider-based physicians requesting confirmation of amount. b) Complex time-consuming fringe benefit model must be completed that uses deduction register amounts by person to support the wage index fringe amounts and physician fringe benefits. c) Audit general ledger reconciliations to ensure accuracy. d) Complete third-party general ledger account reconciliations. e) Gather require information for internal and external auditors for company audits and for Medicare audits. f) Maintain current knowledge of Medicare regulations for the Medicare Cost Report. g) Maintain Medicare cost report software (HFS, HFS-IRIS). Work with IS and decision support to obtain download, queries to support cost report schedules. Audit accuracy of the reports against payroll and GL sources. h) Prepare supporting schedules for both hospitals for the Medicare cost report filings and load into the cost report software. i) Cultivate relationships with key contacts at insurance companies and manage care organization. CMS and medical professional societies. j) Coordinate third party audits, defend preferential reporting practices and maintain current knowledge of Medicare and Medicaid reimbursement regulation. k) Provide overall follow-up and coordination with Medicare and Medicare HMO plans and process with Medicare and Medicare HMO adjustments.
2. Tricare Capital and Residency Cost Reports a) Ensure 100% compliance with eligibility requirements and accuracy – days, interest, and depreciation. b) Upon receipt of final cost report from Medicare, must respond within 30 days with a revised filing if any numbers change that effect the calculation of Tricare’s share of capital.
3. Reimbursement Reports & Analysis a) Track reimbursement trends for case mix, payer statistics, etc. as assigned to anticipate potential reimbursement shortfalls. b) Update Medicare physician fee schedules for Delaware, Medicare OP PPS schedule to reflect expected reimbursement by CPT code for MMH and KGH separately, and distribute Lab Fee schedule.
4. Reimbursement other activities a) Prepare annual Champus/Tricare capital reimbursement filing and investigate any discrepancies. b) Review problem areas such as, inpatient rehab, therapies, dialysis, etc. that are heavily Medicare reimbursed on a quarterly basis. Suggest strategies for improved reimbursement. c) Audit inpatient and outpatient Medicare and Tricare claims for payment accuracy and potential billing improvements.
5. All other duties as assigned within the scope and range of job responsibilities

REQUIRED MINIMUM EDUCATION AND CREDENTIAL:

• Education Bachelor Degree
  Accounting
  
  
  
• Credential

EXPERIENCE:

Required: Two years of work experience in finance or patient accounting Preferred: Five years hospital finance in cost accounting or reimbursement, or patient accounting.

PREFERRED EDUCATION AND CREDENTIAL:

• Education Master Degree
  Business Administration
  
  
  
• Credential

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