Senior Reimbursement Analyst

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  • Oakland, CA
  • Finance
  • Reimbursement
  • Full Time - Day
  • Business Professional & IT
  • Req #: 24890-16275
  • Posted: September 25, 2019
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Job Summary: The Senior Reimbursement Analyst will be responsible for a number of complex and higher level assignments. This position is expected to function independently with a minimum amount of oversight while independently performing reimbursement related tasks and projects, many with externally imposed deadlines and significant financial exposure. This position is intended to improve revenue and reimbursement streams; revenue accounting, resource preservation; appeals and cost reporting. Will lead team for assigned reimbursement projects. Performs related duties as required.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1.  Accurately prepares and assembles financial and statistical reports required by governmental and third party agencies consistent with current regulations and contract terms.


2.  Analyzes and models financial and statistical data used in third party reimbursement.


3.  Assists with determination of cost and revenue allocations subject to County Realignment funds.


4.  Develops and maintains revenue modeling systems. 


5.  Estimates Medicare, Medi-Cal, and third party payer contractuals and bad debt allowances; prepares journal entries for recording allowances and reserves.


6.  Leads modeling and analyzing cash forecasts and developing cash management reports.


7.  Leads the preparation of reports and spreadsheets required under the California Medi-Cal Waiver program.


8.  May act as a mentor to junior analysts/staff as required.


9.  Member of contract negotiation team for supplemental funding streams. 


10. Participate and/or leads the preparation of Medicare and Medi-Cost cost reports, and OSPHD reports.


11. Participate in the development and maintenance of AHS cost allocation model.


12. Participates and/or leads the support of work paper development and tasks related to external financial audits.


13. Preparation of annual PPS Reconciliation reports for the system's FQHC's.


14. Prepares and validates contracts between the Hospital, DHCS and Provider Plans required under the Managed Medi-Cal supplemental rate range and SPD programs. 


15. Projects and reconciles periodic Medicare interim (PIP)  payments. 


16. Provides other project support and may provide administrative support to the Director, Reimbursement as needed.


17. Reconciles accounts receivable subsidiary ledgers/systems to the general   ledger, including, but not limited to, government patient admission logs.


18. Values patient and payor accounts receivable and related third party settlements.

Education: Bachelor's Degree with major coursework in business, accounting, economics or a field related to work.  Additional professional or para-professional experience may be substituted for the eductation on a year-for-year basis.
Minimum Experience: Five years professional-level experience within Finance or two years within a Reimbursement environment in a healthcare setting.
Preferred Licenses/Certifications: Any HFMA or related professional organization certificates are desirable.


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