Sr. Reimbursement Analyst

Job Description

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

The Senior Reimbursement Analyst is responsible for the integrity of net revenue and providing cost report preparation, cost report appeals, audit preparation and other duties related to the regulatory reimbursement services of ECU Health. The position maintains current knowledge of Medicare, Medicaid and other State and Federal regulations. The Sr. Reimbursement Analyst interacts with customers and ensures value is delivered and customer satisfaction is achieved. Assists in coordination of net revenue functions related to the strategic financial planning process. The Sr. Reimbursement Analyst also assists in the improvement of internal business processes and meeting future reimbursement service needs.

Responsibilities

1. Prepares interim estimates and annual cost reports for Medicare, Medicaid and other State or Federal agencies for ECU Health facilities. Proficient in the use of Cost Report software.

2. Prepares, monthly reserve models and provides thorough analysis of net revenue variances for assigned entities to include, bad debt and other revenue adjustments in accordance with ECU Health policies and procedures. Prepares Third Party Settlement estimates and maintains reconciliation of related balance sheet accounts. Analyzes and reports changes in monthly reserves. Investigates and makes recommendations for updates to assumptions and/or methodology.

3. Provides projections and analytical support during fiscal year budgeted net revenue preparation.

4. Assists in the maintenance of standardized policies and procedures for the Reimbursement Department.  Reviews operational reports, identifies opportunities/problems, and makes recommendations for improving processes methodologies. Trains reimbursement analysts in the department on new responsibilities.

5.Coordinates the Medicare, Medicaid and other State or Federal agency cost report audits, providing supporting documentation, reviewing audit adjustments, and responding to audit findings in a timely and efficient manner.

6.  Maintains working knowledge of NC Medicaid Programs to include but no limited to HASP, Direct and Enhanced Payments. Records appropriate entries to the applicable ECU facilities for payments received. Completes schedules as required by the state of NC.

7.  Maintains working knowledge of net revenue software and works with IT/Vendors to ensure information is updated timely to accurately record net revenue at ECU Health Entities. Extracts and processes data to support review of net revenue.

8. Maintains working knowledge of Indirect and Direct Medical Education and provides request reimbursement analysis on Program Changes.

9. Supports ECU Health Financial Statement audit as it pertains to Net Revenue. Provides support for balance sheet reserves and estimates. Performs analysis for variance inquiries.

10.Completes special projects as required.

Minimum Requirements

• Bachelor's Degree required.
• Associates degree with 15 years of reimbursement experience can be substituted for the Bachelor's Degree.
• Minimum Five Years of Experience with Medicare and Medicaid experience in a Reimbursement Department. Working knowledge of reimbursement regulations and complex healthcare environment is required.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.