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Orlando Health · 3 weeks ago

Sr. Reimbursement Consultant - Medicaid/Medicare Reimbursement

Orlando, FL

Full-time

Onsite

Senior Level

5+ years exp

Orlando Health is a trusted healthcare organization dedicated to providing professional and compassionate care. The Sr. Reimbursement Consultant is responsible for the financial analysis, processes, accounting, and reporting for reimbursement activities for assigned hospitals, ensuring compliance with state and federal regulations.

Health CareHospitalMedicalNon Profit

Responsibilities

Responsible for accurate preparation and submission of health system Medicare and the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) cost reports and amendments, re-openings and appeals, if applicable, in accordance with State and Federal regulations

Provides specific expertise in the areas of Medical Education, Bad Debts, DSH, Wage Index, and S-10 reporting for the complex health system

Coordinates procurement/completion of time studies, rotation schedules, statistics, available bed counts, and bad debt logs throughout the fiscal year needed to complete cost reports. Provide support for any external reviews done to optimize reimbursement, such as DSH, BD, WI, and S-10

Coordinates any health system audits conducted by or on behalf of Medicare and/or Medicaid agencies, and challenges adverse adjustments. Communicates with the appropriate levels of governmental auditors as appropriate and review documentation to ensure appropriate reimbursement

Maintains knowledge of current regulations and reviews proposed changes that impact the health system's reimbursement. Disseminate changes in reimbursement to the appropriate levels of management to foster informed decision-making and compliance with laws and regulations. Assists with development of any record-keeping policies and procedures required by new/changing regulations or payment methods

Prepares the annual State DSH/LIP Surveys, 990 Schedule H, and other required filings and related audit defense

Maintains updated enrollment records and submits revalidations and provider-based attestations for new and existing facilities and services. Provides any needed support for the enrollment of any additional 340B sites. Monitors area wage index and file MGCRB reclassification requests if beneficial

Calculates and analyzes third-party settlement balances and reserves on a monthly/annual basis and make applicable adjustments. Provides documentation during year-end financial audits that support third-party receivables/payables, such as detailed workpapers and MAC correspondence

Identifies and implements process improvement opportunities while always looking for ways to optimize reimbursement

Participates in project teams to provide reimbursement expertise necessary in the decision-making process. Conducts reimbursement impact analyses and prepares provider comment letters to propose regulatory changes that are submitted to CMS for consideration. Performs other projects as assigned

Maintains compliance with all Orlando Health policies and procedures

Effectively communicates complex financial models to a wide variety of audiences through verbal and written presentations

Manages large projects and oversees leadership of cross-functional teams

Participate in/attend meetings as required. May be asked to chair or lead meetings

Complete all Orlando Health mandatory education

Assumes responsibility for professional development and continuing education

Qualification

Medicare cost reportsFinancial analysisReimbursement softwareCPA certificationMicrosoft OfficeProcess improvementProject managementCommunication skillsTeam leadership