Job Description

The Healthcare Reimbursement Specialist ensures accurate and compliant reimbursement and case mix transactions in alignment with CMS, state, and contractual requirements. This role is responsible for analyzing proposed reimbursement changes, developing financial reports, supporting Medicare cost report preparation, and providing insights on reimbursement strategy. The specialist collaborates with the Director of Reimbursement and Controller to assess legislative and contractual impacts, maintain financial system reporting, and support cost accounting functions across Beacon Health System.

Mission, Values & Service Goals

MISSION:

We deliver outstanding care, inspire health, and connect with heart.

VALUES:

• Trust
• Respect
• Integrity
• Compassion

Key Responsibilities

Reimbursement Analysis & Reporting

• Review 835 files to identify and resolve transaction errors.
• Prepare and update monthly contractual allowance analyses for general ledger reporting.
• Analyze the financial impact of proposed reimbursement changes for governmental and commercial payors.
• Program and generate financial reports using data from systems such as PeopleSoft, McKesson, and PIC.
• Maintain reimbursement tables and software settings to ensure accuracy.
• Configure and update reimbursement contracts within contract and denial management systems.
• Test and validate new software updates to ensure accurate reimbursement calculations.

Cost Report & Wage Index Preparation

• Prepare statistical and supporting worksheets for Medicare cost reports and wage index filings.
• Collect required departmental data and input it accurately into cost report software.
• Maintain up-to-date cost report files and systems.
• Support Medicare and Medicaid cost report appeals by compiling CMS-compliant documentation.
• Coordinate with external parties to obtain labor data for wage index inclusion.

Audit Support

• Prepare documentation and workpapers for year-end audits and cost report reviews.
• Respond to auditor inquiries and resolve outstanding issues in a timely manner.
• Deliver accurate and complete information as requested.

Cross-Departmental Support

• Develop and deliver custom financial and reimbursement reports for internal departments.
• Respond to ad hoc analysis requests from leadership.
• Provide financial insight to support data-driven decisions across the organization.

Other Duties

• Design and generate reports to analyze accounts receivable and cost vs. reimbursement metrics.
• Complete additional assignments and special projects as directed.

Organizational Responsibilities

• Actively participate in departmental meetings and discussions.
• Complete all mandatory education, annual competencies, and health requirements on time.
• Maintain all required licenses and certifications in good standing.
• Adhere to organizational policies, regulatory requirements, and infection control practices.
• Be available to work overtime or alternative schedules as needed.

Qualifications

Education & Experience

• Bachelor’s degree in Business Administration, Accounting, Finance, or a related field required.
• Minimum of 3 years of experience in healthcare reimbursement or cost accounting preferred.

Knowledge & Skills

• Strong understanding of Medicare/Medicaid and managed care reimbursement methodologies.
• Proficient in hospital cost reporting processes and related regulatory requirements.
• Advanced Excel skills; experience with financial systems and report generation tools.
• Excellent analytical skills and attention to detail.
• Effective communication skills with the ability to collaborate across departments.
• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.
• Commitment to Beacon Health System’s mission, values, and service excellence.

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