Sutter Health Reimbursement Analyst (Technical Analyst) - Sutter Health System Office in Roseville, California
Under the general guidance and supervision the duties of this position include completing accurate annual Medicare cost reports for complex acute hospitals, including those with distinct part psychiatric, rehabilitation, SNF, HHA, CORF, organ transplant, resident and RHC programs. It is incumbent upon this position to ensure the reports are in full compliance with current laws and regulations. These reports include all required supplemental data reports such as: (a) CMS Form 339, (b) Wage Index data, (c) Medicare bad debts and (d) physicians compensation information.
Duties include completing accurate annual California Department of Health Services (DHS), Medicaid (Medi-Cal) cost reports and all related supplemental reports such as: (a) Medi-Cal supplemental report for acute hospitals under contract and non-contract arrangements, (b) County Medical Services Program (CMSP) and (c) Rate Development Branch.
This position works closely with Medicare and Medi-Cal Auditors during audit process providing requested supporting documentation.
Duties include reviewing up to four Sutter Health affiliates’ submitted monthly contractual calculations with the supervision and review by the Reimbursement Manager and/or Sr. Reimbursement Specialist.
The person in this position will help prepare and submit special reports required by the California DHS and Medicare fiscal Intermediaries in conjunction with cost report submission and settlement analysis.
Other special projects will be occasionally assigned.
A Bachelor's Degree in Finance, Healthcare Administration, or Information Technology is required. Minimum 2 - 5 years experience in the healthcare environment.
Must have experience in healthcare, auditing, working, analyzing and completing Medicare cost reports (CMS Form 2552-96 and CMS Form 339), and Medi-Cal cost reports with related supplemental schedules (A & I Forms). Must have knowledge in the application and treatment of revenues and expenses, and various payment methodologies used by the Medicare and Medi-Cal programs. This level is typically obtained in 3 to 4 years of direct experience.
Must have the experience and thorough understanding of the correct application and calculation of Medicare and Medi-Cal entitlements, applying current Medicare and Medi-Cal laws and regulations governing facility entitlements under Title XVIII and Title XIX for Acute Hospitals, Skilled Nursing Facilities (SNF), Home Health Agencies (HHA), Rural Health Clinics (RHC), Psychiatric Hospitals, Rehabilitation Units, and hospitals with medical education and organ transplant programs.
Must have experience working and understanding the hospital accounting systems, accrual basis of accounting, audit processes, and working paper presentation and cross-referencing.
Must have experience in the application and use of licensed Medicare/Medi-Cal cost report software programs.
Must have a good understanding of accounts receivable valuation methodologies and calculation of contractual allowances.
Must have experience using personal computers and related software applications such as (a) spreadsheets, (b) word processing, (c) e-mail and (d) cost reporting software. Experience with the MedSeries4 mainframe system is considered a plus.
*• Required to have performed routine product reviews to identify issues and areas for improvement.
• Required to have the knowledge of processing data for analysis (cleansing, modifying, and formatting) and mapping data across various systems
• Required to have the ability to compile periodic reports with metrics by product, detailing issue category, frequency, cause, preventive recommendations and trends.
• Required to have the ability to provide QA support by finding data problems in any data repository including spreadsheets, spreadsheet formulas and SQL Server tables.*
Must be knowledgeable and understand all of the Medicare and Medi-Cal compliance cost reporting requirements.
Must be knowledgeable and understand the laws and regulations governing Medicare and Medi-Cal reimbursement affecting Acute Hospitals, Psychiatric Hospitals, Physical Rehabilitation Units, SNF, HHA, RHC, and inpatient and outpatient payment systems under Title XVIII and Title XIX of the Act.
Must be knowledgeable and understand hospital accounting system and the accrual basis of accounting.
Must know how to use personal computer and related applications such as (a)spreadsheet, (b) word-processing (c) e-mail and (d) cost reporting software application. Knowledge of the MedSeries4 system is considered a plus.
Must know how to write brief and concise reports.
Must know how to create and cross-reference working papers with supporting documents.
Must know and understand how to apply and use statistical models.
*• 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 and tools using MS SQL Server, Crystal Reports 2008, Excel and Access.
• Evaluate database schemas and query data using T-SQL techniques to support the reporting and application needs of the department.
• Maintain, enhance and eventually rebuild the Reimbursement Department Tools using Visual Studio, SQL Server and MS Team Foundation.*
Special Skills/Equipment :
Strong organizational and planning skills.
Strong written, verbal and interpersonal and presentation skills.
Strong reading and comprehension abilities to understand and interpret complex laws and regulations issued by CMS and California DHS such as Medicare and Medicaid regulations published in the Federal Register.
Strong analytical, evaluative and statistical skills.
Ability to handle shifting priorities and multiple projects simultaneously.
Must have the ability to adhere to critical deadlines.
Must be knowledgeable and efficient in the use of personal computers and related applications.
Must have a valid California Drivers License.
Must be able to work with very minimum supervision.
*• Excel skills with knowledge of advanced table and graph/charting functions.
• Experience with Clarity/EPIC
• Experience with SQL, T-SQL, PL-SQL and SSIS
• Experience with Visual Studio, Visio, Crystal, and MS Access
• Knowledge with developing new databases with the ability to create and modify System Tables, Views, Stored Procedure and Functions
• Knowledge with Indexes, Triggers and Keys
• Knowledge of SQL Server Databases*
Organization: *Sutter Health System Office
Title: Reimbursement Analyst (Technical Analyst) - Sutter Health System Office
Location: California-Greater Sacramento Area-Roseville
Requisition ID: SHSO-1627270