Reimbursement Analyst

New Hanover Regional Medical Center

Introduction:

New Hanover Regional Medical Center is a not-for-profit health care system serving southeastern North Carolina and northeastern South Carolina. A teaching hospital, regional referral center, and Level 2 Trauma Center, NHRMC is dedicated to providing a wide range of health care services. Our mission is Leading Our Community to Outstanding Health, a bold statement that reinforces our goal to reach far beyond the walls of our hospitals and into the communities that rely on us for their care.

If you are looking to take the next step in your career, Wilmington, NC is a growing coastal community of around 100,000 people in Southeastern North Carolina. Enjoy living and working where most people vacation. Year-round boating, golf, fishing, tennis, and biking are available. We have a vibrant, historical downtown with excellent restaurants and an active cultural arts community.

Job Description:

New Hanover Regional Medical Center is searching for a Reimbursement Analyst, who works under the supervision of the Reimbursement Department Coordinator/Manager.  The position is one of the hospital’s contacts with Federal and State payers for reimbursement issues. Completes all schedules and forms for Medicare, Medicaid and Tricare cost reports; monthly and budget third party reserves third party payer allowances and cost report audits all under the supervision, direction and review of the Reimbursement Coordinator/Manager. Updates CMS 855A Medicare Provider Enrollment. Assists the Manager in the research and development of net revenue enhancement opportunities. Customer and team oriented resource to accomplish departmental goals in a timely, accurate, efficient and positive manner.

Primary Job Duties:

  • This position tracks Medicare, Medicaid and Tricare rates.
  • Works with Federal and State payer staff for audit and rate setting.  Reviews for accurate settlement calculations with Medicare, Medicaid and Tricare.  Reviews proposed audit adjustments and responds to audit requests.
  • Researches and develop opportunities for net revenue enhancement.
  • Analyzes legislation and regulations impacting hospital revenues.  Obtains an increasing knowledge of Medicare/Medicaid regulations.
  • Completes cost report work papers and completes the cost report forms (for example CMS 2552 or CMS 1728 forms) for Medicare, Medicaid and Tricare cost reports, including interim reports.  
  • Completes monthly Medicare, Medicaid and Tricare AR allowances and net revenue computation.
  • Completes monthly third party reserve work papers, and for Medicare, Medicaid, Tricare and Medicare HMO net revenue budgets.  Tracks prior year cost report receivables/payables including review and recommendation of adjustments to third party reserves.
  • Prepares IRIS filing.  Maintains Interns and Residents data in accordance with Medicare regulations to be both compliant and maximize reimbursement.  Prepares Indirect and Direct Graduate Medical Education analysis.
  • Assists with Medicare Disproportionate Share (DSH) and North Carolina Medicaid Reimbursement Initiative (MRI) filings: Medicaid Eligibility, Unreimbursed Uninsured, DSH eligibility; monitors legislative developments.
  • Prepares Medicare Occupational Mix Survey and Wage Index.
  • Updates of the Hospital’s CMS 855A and related Provider-Based applications.
  • Provides reimbursement factors for government payers to be used in hospital systems such as EPIC Hospital Billing, EPIC Contract Manager, 3M, and ADS.
  • Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
  • Performs other duties as assigned.

 

Required Qualifications:

  • Four or more years preparing or auditing cost reports 
  • Experience with third party payment regulations and form CMS 855A
  • Proficient with PC based applications and hospital systems

 

Preferred Qualifications:

  • Master’s degree preferred
  • CPA and/or HFMA certification preferred
  • Experience with teaching hospital preferred

 

Education Qualifications:

Education: Bachelor’s Degree in Accounting from an accredited institution required

Instructions for Resume Submission:

Please visit our website and submit your application directly:
https://www.nhrmc.org/careers