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Government Program Analyst - Reimbursement

This job posting is no longer active.

Job ID: 5865
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

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Job Description


Become part of an inclusive organization with over 30,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

This position may involve support of various hospitals and health care systems within the UNC Health Care System, but will be employed by Rex Hospital, Inc. (this includes, but is not limited to, for purposes of payroll, health benefits, retirement options, and applicable policies).

Responsible for research, analysis and review, and internal consulting in preparation for filing the annual Medicare, Medicaid, and Champus/Tricare cost reports for UNC Health Care System. Prepares cost report re-openings and appeal papers, audit preparation and other cost report settlement activity and related supporting reserve worksheets for the CFO's to use in financial statement preparation. Collaborates with Management in the reimbursement regulations and regulatory, operational, and financial impacts of proposed operational decisions throughout the UNCHC system.

1. Collaborate with Senior Leaders across affiliates to advise on regulatory issues such as requirements for change of ownership, change of year end, change of bed size Graduate Medical education reimbursement (GME), , operational change (bad debts, capitalization, etc. ) impacts to reimbursements, regulations and the structures required by CMS. Educate senior leaders, staff, and directors on the applicable regulations and its impact.
2. Collaborates with other staff members, department heads and senior leaders to furnish the Medicare and/or Medicaid auditors with the supporting documentation to minimize adjustments to the cost reports, wage index, DSH audits, etc. Researches regulations, Medicaid State Plan, prior court cases, PRRB rulings, etc. to rebut the proposed adjustments to support UNC Health Care?s position. Presents UNC Health Care?s position in support of adjustments for the auditors and negotiates with the auditor, his supervisor as the representative for UNCHCS provider (hospital, skilled nursing facilty, etc.)
3. Coordinates the preparation of other supplemental activities such as presumptive testing for Rehab provider, cost report amendments, reopenings of prior settled cost reports, appeal papers with attorneys as applicable, providing and preparing the supporting documentation for the reopening, amended, appeal, the effects of changes in the regulations, of the disproportionate share schedules for Medicaid, surveys for the Hospitals such as the College of Teaching Hospitals and Association of American Medical Colleges and other reports or surveys as requested by senior leaders and CMS. Also, coordinate the data submission and physician validation for physician supplemental payments and report and work with legislative parties for State Plan Amendments.
4. Gathers necessary information to complete the cost report. Collaborates with the departments which maintain statistical data, accounting data, census data, resident rotations, resident?s demographics, faculty costs and benefits, decision support data and bad debts to ensure the departments are aware of the regulations, data, and the appropriate format to facilitate its use.
5. Incorporates, manipulates and analyzes complex databases from finance, payroll, accounts payable and the Federal and State claims databases to compile the Medicare, Medicaid and Tricare cost reports while maintaining compliance with the applicable Centers for Medicare and Medicaid Services (CMS) regulations. Analyzes data for cost reports and applies regulations to determine allowable costs, charges, residents full time equivalents and physician?s costs evaluating legal contractual arrangements for allowability.
6. Monitors compliance with policies and procedures and makes recommendations for changes as appropriate. Facilitate any changes to UNCHCS operational policies and procedures as it pertains to the applicable hospital or facility working work closely with Senior leaders such as system controller, controllers, CFO?s, VP?s, etc. Educate all levels of staff on the regulations and necessary changes to operational processes and procedures.
7. Prepares the CMS forms required by the Federal Register and local fiscal intermediary for the Wage Index and Occupational Mix. Ensures supporting documentation is clear. Collaborates with the Controllers, CFO?s, Accts Payable Managers etc. at the UNCHCS hospitals to gather the information and compile as required by CMS in a compliant manner. Determine, assess, and prepare the county or individual reclassification and work with other non-UNCHCS hospitals to coordinate the timely application. Educate and facilitate discussions with above parties in UNCHCS regarding ways to maximize the wage index in a compliant manner. Collaborate with other non-UNCHCS hospitals that are in the applicable CBSA so as to maximize the resulting Wage Index for all UNCHCS hospitals in the CBSA .
8. Work closely with his/ her appointed facility CFO, Controller to answer and support their jobs in that the analyst supplies answers to reimbursement questions. Participate in monthly numbers call with the system level CFO, CEO, etc. Work closely with hospital Controller and CFO to prepare and update the monthly and yearly reserve worksheets.

Other Information

Other information:
Education Requirements:
● Bachelor’s degree in Accounting, Business Administration, Finance or related field (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● If a Bachelor's degree: Five (5) years of fiscal intermediary audit experience, hospital based reimbursement, or extensive accounting experience within a hospital.
● If an Associate's degree: Nine (9) years of fiscal intermediary audit experience, hospital based reimbursement, or extensive accounting experience within a hospital.
● If a High School diploma or GED: Thirteen (13) years of fiscal intermediary audit experience, hospital based reimbursement, or extensive accounting experience within a hospital.
Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Reimbursement 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: Morrisville:NC

Exempt From Overtime: Exempt: Yes

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care. This is not a State employed position.
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The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.

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