Senior Medicaid and Medicare Reimbursement Consultant

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Prepare and assess Medicare and Medicaid cost reports for all OhioHealth entities.

• Ensure that OhioHealth receives the appropriate governmental reimbursements.

• Calculate and model the effects of regulatory changes.

• Conduct variance analysis on third-party liability accounts.

• Prepare supporting documentation and work papers for inquiries from third parties.

• Provide supervisory oversight for the daily work schedule, information flow, training, work review, and priorities of the Reimbursement Analyst.

• Assist the Director of Revenue and Reimbursement and the Manager of Reimbursement with revenue cycle management, charge analysis, and regulatory and financial reporting analyses.

• Act as a subject matter expert in areas such as S-10, Wage Index, Bad Debts, Medicare Audits, Disproportionate Share, IME, GME, Governmental Logs, HCAP, UPL, and Franchise Fee programs.

• Lead, advise, and consult on reimbursement financial projects and special initiatives.

• Delegate project or process assignments while maintaining strategic oversight.

• Provide consultation on reimbursement functions for facilities in central and non-central Ohio.

• Keep the Director of Revenue and Reimbursement and the Manager of Reimbursement informed of updates.

• Collaborate with CGS audits and auditors.

• Work with legal vendors on Medicare appeals.

• Collaborate with OHA and CBSA facilities to explore wage index opportunities.

⛳️ Requirements

• A Bachelor’s Degree in Finance is required.

• Proficiency in Microsoft applications is essential.

• Familiarity with clinical and financial patient management systems.

• Proven capability in financial analysis and cost reporting.

• Extensive understanding of Medicare and Medicaid cost reporting and reimbursement processes.

• Current knowledge of federal and state regulatory requirements.

• Comprehensive knowledge of CMS cost reporting, disproportionate share (DSH), Uncompensated Care, bad debt reporting, IME/GME, Medicare Wage Index, S-10 reporting, Tricare and 855s, Ohio Medicaid, HCAP, UPL, and Franchise Fee programs.

• Understanding of Acute Care Hospitals, Critical Access Hospitals, Sole Community Hospitals, and Rural Health Clinics.

• Knowledge of reimbursement practices in psychiatry, inpatient rehabilitation units, Home Health, and Hospice services.

• Excellent prioritization, communication, planning, and interpersonal skills.

• Ability to delegate tasks and supervise the activities of Reimbursement Analysts.

• Capacity to communicate effectively with all levels of management.

• Ability to thrive in a heavily matrixed environment.

🏝️ Benefits

• Full-time position.

• Day shift schedule.

• 40 hours of scheduled work per week.

• Remote work opportunity from Ohio.