Sutter Health Senior Reimbursement Analyst in Roseville, California
This position plans, designs, develops and maintains an extensive support system for all Sutter Health affiliates and/or associates including (a) Acute Hospitals, (b) Psychiatric Hospitals, (c) Rehabilitation Units, (d) Home Health Agencies, (e) Skilled Nursing Facilities, (f) Rural Health Clinics. Prepares, completes, and submits the annual Medicare and Medi-Cal compliance Cost Reports with all the required supplemental schedules. Functionally supervises by directing, reviewing, training, and developing the Reimbursement Analyst’s work and skills in a positive professional manner. Reviews all Medicare and Medi-Cal audit adjustments, initiating, and following up any appeal process with HCFA and DHS. Interacts with Medicare and Medi-Cal Auditors, both internal and outside legal counsel, facility Administrators, CFOs, Controllers, and other management support staff; therefore it is incumbent upon this position to maintain good professional working relations. Also provides support to (a) management personnel during the budget process, (b) Managed Care Dept. personnel during the negotiation process, (c) Sutter Health entities monthly and yearly contractual reviews, (d) provide third party reimbursement analysis, and (e) provide system and affiliate management with multi-year projections on government payer revenues based on newly enacted or proposed legislation.
A Bachelor's Degree in Finance, Healthcare Administration, Information Technology or related field is desired. The equivalent combination of certifications, training, and 5 -10 years experience may be considered.
Experience in healthcare to have developed extensive knowledge in the proper application, compliance and treatment of health care operational activities, Medicare and Medi-Cal Laws and Regulations governing facility entitlements under Title XVIII and Title XXII as is typically obtained in 5-7 years. In addition, experience required for this position includes the following:
• Demonstrated ability to read, research, interpret and implement government laws and regulations and changes thereof.
• Must have demonstrated experience in the preparation and completion of Medicare and Medi-Cal Cost Reports.
• Must have the ability to coordinate and work with Medicare and Medi-Cal Auditors, as well as be knowledgeable in both Medicare and Medi-Cal audit and appeal processes.
• Must have demonstrated experience in preparing Medicare and Medi-Cal audit appeals position papers and documentation that meets all requirements as stipulated by Medicare and Medi-Cal regulations governing the Appeal Procedures.
• Must have directed the preparation of the annual Medicare and Medi-Cal cost report, and the California Annual Hospital Financial Disclosure Report (OSHPD)
• Must be knowledgeable and have performed and/or developed calculations of contractual allowance amounts recorded in the Hospital’s general ledger.
• Required the ability to performed routine product reviews to identify issues and improvements.
• Required the ability to process data for analysis (cleansing, modifying, and formatting) and mapping data across various systems
• Required the ability to compile periodic reports with metrics by product, detailing issue category, frequency, cause, preventive recommendations and trends.
• Required the ability to provide QA support by finding data problems in any data repository including spreadsheets and spreadsheet formulas and SQL Server tables.
• Required the ability to read/modify/create complex T-SQL queries, SP’s as needed.
• Must be knowledgeable and thoroughly understand the various Medicare and Medi-Cal cost reporting and compliance requirements.
• Must be knowledgeable in both old and current Medicare and Medi-Cal Laws and regulations governing reimbursement related to Acute Hospitals, Psychiatric Hospitals, Rehabilitation Unit, Skilled Nursing Facilities, Rural Health Clinics, Inpatient and Outpatient pay system, Medi-Cal payment system and regulations under Title XXII.
• Must be knowledgeable and understand the California Annual Hospital financial Disclosure reporting process and requirements.
• Must have thorough knowledge of the hospital accounting system, audit processes, workpapers presentation, computer skills, and automated Medicare/Medi-Cal cost report software.
• Must be knowledgeable in the use of personal computer and its applications, such as: spreadsheet, word-processing, and cost reporting software application.
• Must be proficient and know how to write brief and concise reports.
• Must be knowledgeable in creating and developing workpapers with supporting documents to establish audit trails to support cost report data.
• Must know and understand how to apply statistical methods.
• Must be able to perform and complete work assignments effectively and accurately with very minimal direction and supervision.
• Design, build and maintain custom solutions in order to streamline the department’s current workflow/processes and improve efficiency. Evaluate current processes and make recommendations when significant improvements can be achieved through the use of automation.
• Create custom reports using MS SQL Server, MS Reporting Services, Crystal Reports 2008 and Excel.
• Evaluate complex database schemas and query data using advanced T-SQL techniques to support the reporting and application needs of the department.
• Database design & maintenance.
Special Skills/Equipment :
• Must have excellent organizational, analytical and planning skills.
• Must have demonstrated leadership, adult training and education skills.
• Must have ability to determine reasonableness of data acquired from various sources.
• Must have excellent written, verbal and interpersonal and presentation skills.
• Must be able to work with all levels of management and translate complex rules and regulation issues, requirements to non-reimbursement staff at the facility level.
• Must have the ability to constantly maintain a professional working relationship with various personnel during difficult situations.
• Must possess the skill to negotiate and persuade when needed.
• Must have the ability to handle shifting priorities and multiple projects independently and simultaneously.
• Must be able to work independently with very minimum supervision.
• Must have the ability to read and interpret government regulations.
• Must have the ability to work on various assignments (example: 3-5 hospital cost reports at one time) and adhere to critical deadlines.
• Must be knowledgeable and proficient in the use of Personal Computers, spreadsheets and word-processing software, and cost report software
• Must have a valid California Drivers License.
• Excel skills with a working knowledge of advanced table and graph/charting functions.
• Experience with SQL, T-SQL, PL-SQL, SSIS, SSRS
• Experience with ETL processes
• Experience with developing new databases with the ability to create and modify System Tables, Views, Stored Procedure and Functions
• Experience with Indexes, Triggers and Keys
• Experience with Visual Studio, Visio, and Crystal Report, UltraEdit
• Experience with system and database migration
• Experience with Data Profiling and Data Segmentation
• Knowledge of SQL Server Databases
• Must be able to sit and work at a computer for extended periods of time (5-8 hours daily).
• Must be able to travel throughout Northern California with some overnight stays out of town.
• Must be able to adapt and work in areas while working on-site at the facility.
• Must be able to lift weights (5-30 lbs.) to carry workpapers files, retrieve various documents.
Primary Location: California, Greater Sacramento Area, Roseville
Organization: Sutter Health System Office
Employee Status: Regular
Position Status: Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: None
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.