Building Location:
Fargo Distribution Serv Center
Department:
1007070 GOVERNMENT REIMBURSEMENT - EH SS
Job Description:
The Senior Government Reimbursement Analyst is responsible for the accuracy, reporting and compliance of over $1 billion of government payer reimbursement. Provides support to the Reimbursement Senior Manager to ensure accuracy and maximization of government payer reimbursement. Responsible for preparing accurate and timely Medicare and Medicaid Cost Reports, Medicaid DSH surveys and other agency surveys on an annual basis. Prepares various reimbursement analyses, reviews, rate calculations, and provides support for various government audits. Verifies and analyzes interim rate calculations and final settlements by third party payers for accuracy. Investigates changes in reimbursement and communicates potential impacts to reimbursement by staying current on government and regulatory changes.
Education Qualifications:
Required Qualifications:
- Requires a Bachelor’s Degree in Accounting, Finance or related field
- Requires minimum 5 years work experience in the healthcare field
- Knowledge of Medicare and Medicaid reimbursement regulations and reporting requirements
- Experience with various Medicare Cost Reports required
- Experience working with Excel and electronic cost reporting software required
Essential Functions and Accountabilities:
- Coordinates and compile Medicare, Medicaid and other third-parties annual cost reports, as required by current regulations, including the development, implementation, and maintenance of time studies, statistics (both utilization and cost allocation), and revenue and expense information for entities within the Essentia Health System.
- Provide independent peer review of cost reports, identifying discrepancies, recommending corrections, and ensuring audit readiness
- Coordinate audits of Cost Reports or other information as required by Medicare and other payers.
- Analyzes impact of audit adjustments and confirms audit issues are consistent with Medicare/Medicaid regulations.
- Coordinates updates to Cost Report software; ensures accuracy of information, ensures updates are incorporated.
- Identify Medicare, Medicaid or other reimbursement issues that should be appealed, recommend appropriate outside resources for pursuing appeals, monitor the process to ensure that appeals or exception request are filed in a timely manner, and follow-up to ensure timely resolution.
- Reviews rate calculations for accuracy and maximization of revenue. Prepares appeals as necessary.
- Complete Critical Access Hospital (CAH) and Rural Health Clinic (RHC) monthly templates and recommend appropriate journal entries
- Evaluate financial impact of regulatory changes on reimbursement.
- Complete on-going evaluations of hospital and clinic designations to optimize reimbursement under current regulations
- Responsible for preparing the Tricare/Champus reimbursement requests for capital and education costs and ad hoc reporting as needed.
- Develops and maintains appropriate documentation for interns and resident tracking, wage index and occupational mix reporting to the Medicare program.
- Reconciles all reimbursement settlement accounts and reviews interim rates and pass through payments monthly.
- Assists with the completion of attestations for provider-based clinics or rural health clinic designations.
- Partner with revenue cycle, finance, and operational teams to improve financial performance
- Assists System Manager in development of policies, procedures, reports, and other tools to improve work product.
- Strong analytical reasoning, critical thinking, judgement and problem solving skills in order to independently assess, interpret, and address complex issue in a continually changing environment.
- Performs Essentia-wide duties as requested by the designated Essentia leader.
- Upholds Essentia Health’s mission, vision, values and ethical standards and demonstrate the behavioral and service expectations as defined in our policies and procedures.
You might be a good fit if you...
- Have hands-on experience compiling Medicare and/or Medicaid cost reports.
- Understand CMS rules and government reimbursement requirements and enjoy applying them to real-world reimbursement work.
- Have worked in a hospital, health system, Medicare Administrative Contractor, or healthcare reimbursement consulting environment.
- Are familiar with areas such as CAH, RHC, PPS, DSH, IME/GME, wage index, provider-based clinics, or cost settlements.
- Enjoy detailed analytical work where accuracy directly impacts reimbursement and compliance.
- Can manage multiple deadlines and stay organized during busy reporting seasons.
- Communicate clearly and comfortably with finance, revenue cycle, operations, auditors, and leadership.
Remote Nature:
- This is a fully remote role
- Position functions in Central Standard Time (CST)
Licensure/Certification Qualifications:
FTE:
1
Possible Remote/Hybrid Option:
Remote
Shift Rotation:
Day Rotation (United States of America)
Shift Start Time:
Shift End Time:
Weekends:
Holidays:
No
Call Obligation:
No
Union:
Union Posting Deadline:
Compensation Range:
$84,364.80 - $126,547.20
Employee Benefits at Essentia Health:
At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.
