Reimbursement Specialist (FT)
Posted on Sep 12, 2019 by Dartmouth-Hitchcock Medical Center
Ensures that DHMC is paid for all services in an accurate and compliant manner, by maintaining a working knowledge of current coding guidelines and charge practice.
Maximizes Medicare/Medicaid reimbursement by utilizing a comprehensive understanding of net revenue calculations, reimbursement methodologies, and compliance issues, etc.
1. Provides analysis for appropriate parties relative to reimbursement methodologies and compliance issues.
2. In conjunction with Compliance and Audit Services (CAS), supports the responses to OIG Audits, RAC Audits, BISC Audits, Third-Party Audits, etc.
3. Performs revenue analysis through monthly contractual allowance computations for Medicare and other third-party payers.
4. Assumes responsibility for the accuracy of the contractual and non-contractual reserve levels.
5. Provides analytical support for the 3rd Party Accounts Receivable.
6. Supports the process for filing the Medicare Cost Report.
7. Assists in the Research and analysis of difficult, third-party claims requiring special attention in order to receive payment to include high dollar claims, international claims, and long-stay complex cases with level of care and medical necessity issues.
8. Assumes responsibility for the accuracy of the expected payment calculations for government payers in the Contract Management system. Must maintain a working knowledge of all contracts with 3rd party payers.
9. Provides analysis/support to customers who request assistance related to expected payments/offsets to net revenue. Customers may include, but are not limited to the Office of Government Relations, Operations, Compliance, Administration, Finance, RMD etc., as well as external requests from the NHHA, Consultants, Law firms, etc.
10. Provides assistance in the calculation of net revenues for the monthly financial statements, projections, the annual budget, product line profitability, and other ad hoc analysis.
11. Reviews regulatory changes and proposals for financial impact, and provide analysis/support for other special projects related to regulatory issues.
12. Provides payment information for external surveys such as the NHHA, AHA and COTH etc.
13. Performs other duties as required or assigned.
Bachelor's degree in finance or accounting (preferred) with3 years of experience in healthcare reimbursement, or the equivalent in education and experience required.
Comprehensive knowledge of medical reimbursement regulations required.
Strong data and analytical skills and abilities are required.
Highly effective verbal/written communications, computer and organization skills are essential.
Must be self-motivated, capable of working independently, and function as a team member.
Must be able to function under time pressures and meet deadlines.
Additional relevant experience in a hospital setting of comparable size and large group practice experience preferred.
Required Licensure/Certification Skills: