COST REIMBURSEMENT ANALYST-HYBRID

This position is hybrid, working from home and on site at Butler Hospital or Westmoreland Hospital.

Job Summary

The Cost Reimbursement Analyst is responsible for Excela Health’s cost reports preparation, data gathering, periodic reporting, analysis of reimbursement related to Medicare and Medicaid, proficient use and updating of all related software, maintain an ongoing understanding of government regulations regarding cost report issues, additional and more direct responsibility with the involvement in any appeals regarding cost report issues through hospital associations, increased work load with consultants on issues regarding reimbursement and training of other reimbursement personnel. Other tasks include the completion of the PHC4 (PA Healthcare Cost Containment Council Report) monitoring the MA Modernization, Tobacco, EMR funding, and other special fundings, as applicable. Continuously looks for ways to improve the performance of the department looking for efficiencies and being a good service provider. Communicates status of tasks/issues and results efficiently and effectively. Performs other duties as required.

Essential Job Functions

• Data gathering
  • Scrutinize source of data and the data received.
  • Remain cognizant of the objective of gathering the data.
  • Gather data in the most efficient and effective manner to streamline processes.
• Analyzing Data
  • Understand Excela Health's operations so that informed analysis can be performed.
  • Understand data to be analyzed so that informed analysis can be performed.
  • Understand objective to analyzing data so that informed analysis can be performed.
  • Organize analysis in a manner to effectively and efficiently communicate findings.
• Communicating Information
  • Prepare analyzed data in a manner so that the reader will understand quickly the purpose for which the information was gathered and the conclusions reached.
  • Be aware of format (font, print ranges, scale, etc.) so that the reader does not have to manage the information.
  • Communicates status of tasks/issues and results in an efficient and effective manner.
• Reporting
  • Prepare and distribute reports on a timely basis, including contract analysis, contract variances from PCON, and other ad hoc reports.
  • Distribute in a timely and effective manner the cost reports and related reports.
• Applies team attitude
  • Actively participates in staff meetings, bringing ideas and volunteering to take on tasks.
• Willingly helps another team member who may be absent or needs help
• Other duties as assigned.

Specialty Functions

• Performs cost reporting data gathering tasks.
  • Prepare monthly DSH and Bad Debt collection information for cost report reimbursement.
  • Gathering step down statistics and patient statistics.
  • Review monthly admission census for IME/GME cost report reimbursement.
• Maintain an ongoing understanding of government regulations that apply to cost report/reimbursement issues with more involvement in what the lobbyists are proposing we push through regulations.
  • Read and attend seminars to maintain knowledge of various regulations and best practices and then apply that knowledge.
• Responsible for cost report software with senior analyst advisement.
  • Thorough understanding of the cost report software to ensure efficient and accurate use.
  • Maintain backup files of old and new software versions to ensure ability to restore, return and revise prior cost reports due to reopening or appeal issues.
  • Understanding of New Innovations IRIS software, reporting residents for IME/GME.
• Review, analyze and document all third-party audit adjustments, recommending either acceptance or rejection of those adjustments and if necessary, prepare any appeals to those adjustments.
  • Responsible for handling all third-party government audits (Medicare and Medicaid).
• Analyze and review all third payer CRA accounts to maintain the integrity of the financial statements. Inform management of any discrepancies and work with the financial auditors at the time of audit.
• Analyze and review government (Medicare) third party interim payment rates and lump sum adjustments.
• Work with outside consultants on a number of items including DSH, Wage Index and Appeals (Pension, SSI, Rural Floor, etc.). Approach upper management as to when we need to employ or update the help of outside consultants.
• Perform any other third-party reimbursement responsibilities required by management.
• Other monthly tasks include collection percent analysis for management

Required Qualifications

• Completion of Bachelor’s Degree in a related field.
• One (1) – three (3) years of experience in finance field with emphasis on health care reimbursement.
• Leadership ability, good organizational skills, independent and critical thinking skills, sound judgment.
• Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.
• Proficiency in the use of Excel Spreadsheets, PowerPoint, and various software programs.

Preferred Qualifications

• Three (3) to Five (5) plus years of hospital financial related work experience including reimbursement, cost reports, and analysis.
• Knowledge of various software applications.
• CPA license.

License, Certification & Clearances

• Act 34-PA Criminal Record Check from the PA State Police system

Supervisory Responsibilities

• This position has no direct supervisory responsibilities, but does serve as a coach and mentor for other positions in the department.

Position Type/Expected Hours of Work

• Incumbent will be scheduled based on operational need (rotate shifts, standby, on-call, etc.).
• Travel may be expected locally between Excela Health locations.

LEAN

• Actively promotes a Lean work culture by performing team member duties to encourage consistent use of LEAN principles and processes, including continually seeking work process improvements. Recognizes the necessity of taking ownership of one’s own motivation, morale, performance and professional development. Strives for behavior consistent with being committed to Excela’s missions, vision and values.

AAP/EEO

• Excela Health is an Equal Opportunity Employer. It is the policy of Excela Health to prohibit discrimination of any type and to afford equal employment opportunities to employees and applicants, without regard to race, color, religion, sex, national origin, age, marital status, non-job related disability, veteran status, or genetic information, or any other protected class. Excela Health will conform to the spirit as well as the letter of all applicable laws and regulations.
• Ability to perform the Essential Functions listed on the Physical Conditions and ability to perform the Essential Functions on the Working Condition chart below.

Work Environment

Effective March 2020 or during pandemic: goggles, face shield and mask are required according to CDC guidelines

Physical Demands

When lift requirement is in excess of 50#, lift assistance (2 person) and/or transfer device is required.