Reimbursement Analyst III - Work From Home

Sutter Health


Date: 1 week ago
City: Roseville, CA
Salary: $46 - $69 / hour
Contract type: Full time
Sutter Health

Organization:

S3-Sutter Shared Services-Valley


Position Overview:

Reviews and analyzes data and documents for the completion and filing of regulatory reports and disclosures, as required by Medicare, Medicaid/Medi-Cal and other state and federal agencies, for the complex and largest affiliates. Reviews Medicare and Medicaid/Medi-Cal audit adjustments, initiating and following-up on appeals process with Health Care Finance Administration (HCFA) and Dept of Health Services (DHS). Provides support to management during budget process, to Managed Care during negotiation process, to affiliates during contractual reviews, and to third parties for reimbursement analysis. Provides system and affiliate management with multi-year projections on government payer revenues based on newly enacted or proposed legislation





  • Proven excellence in data driven insights and recommendations as it relates to hospital chargemasters and market data with the upmost integrity is highly desired.

  • Self-motivation and comfortable working and applying rigor and analyses with large datasets is a plus.

  • Desired experience in SQL, Epic, Clarity, Tableau.



Job Description:



EDUCATION
Equivalent experience will be accepted in lieu of the required degree or diploma.

Bachelor's: Finance, Accounting, Business or Healthcare Administration or related field or equivalent education/experience

PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN:

5 years experience in healthcare reimbursement operations.

5 years experience completing and filing Medicare and Medicaid/Medi-Cal cost reports and supplemental reports, including disclosure report for California Office of Statewide Health Planning and Development (OSHPD).

5 years experience with Medicare and Medicaid/Medi-Cal audit and appeals process, and preparing position papers and required documentation.

5 years experience with calculating contractual allowance amounts recorded in affiliate’s general ledger.

SKILLS AND KNOWLEDGE

Working knowledge and understanding of prior and current medicare and medicaid/medi-cal rules and regulations affecting reimbursement, cost reporting requirements, and audit and appeals process for various types of healthcare facilities.

Working knowledge of applicable state reporting/disclosure requirements e.g., California Office of Statewide Health Planning and Development (OSHPD).

Knowledge of accounts receivable valuation methodology.

Working knowledge of contractual allowance and third party settlement processes.

Knowledge of hospital/patient accounting systems and processes.

Ability to read, comprehend, and apply policies, procedures, practices, and regulatory & legal requirements.

Ability to compute and apply basic mathematical functions and computations, including percentages, decimals and statistics.

Analytical skills to recognize, research and resolve questionable data.

Organization skills and attention to details.

Displays a customer service focus in all decisions and actions.

Ability to prioritize workload to complete assignments accurately and timely, and to meet strict timelines.

Ability to communicate through verbal and written means.

Ability to interact and maintain effective working relationships with those contacted in the performance of required duties.

Demonstrates respect for cultural and linguistic differences and promotes an inclusive work environment.

Demonstrates initiative in providing feedback/input to improve workflow/processes.

Ability to work effectively in a dynamic and fast-paced environment with changing business priorities.

Ability to maintain and work discreetly with confidential information.

Ability to use essential applications and/or databases associated with the role’s duties and responsibilities.

Pay Range: $45.80-$68.70



The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.



Job Shift:


Days


Schedule:


Full Time


Shift Hours:


8


Days of the Week:


Friday, Monday, Thursday, Tuesday, Wednesday


Weekend Requirements:


None


Benefits:


Yes


Unions:


No


This position is work from home eligible.



Position Status:

Non-Exempt


Weekly Hours:

40


Employee Status:

Regular


Number of Openings:

1


Sutter Health Affiliates are equal opportunity employers EOE/M/F/Disability/Veterans.

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