Reimbursement Specialist

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Performs a wide range of finance and accounting functions to support financial reporting and analysis for all facilities within WVUHS. Extensive knowledge of third party reimbursement as it relates to provider based clinics and medical education related to IME and GME Medicare reimbursement. Assists with charge master preparation to ensure accuracy of the HCPCS, CPT codes, revenue codes and pricing.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school diploma or equivalent.

EXPERIENCE:

1. Five (5) years of hospital, coding or physician reimbursement experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in Finance, Accounting, Business, Health Care or related field.

EXPERIENCE:

1. Coding or physician reimbursement experience.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Develops and coordinates the process to track Intern & Resident information for approximately 500 Residents for the Medicare Cost Report.

2. Responsible for ensuring accurate IME (Indirect Medical Education) and GME (Direct Graduate Medical Education) reimbursement from Medicare, which is approximately $25 million.

3. Educates Resident Coordinators annually on data requirements. Provides training to any new resident coordinator.

4. Coordinates the annual Medicare audit related to Medical Education reimbursement. Ensures that all required data is available and accurate. Responds to and resolves audit issues in a timely manner.

5. Reviews and interprets all new reimbursement legislation related to Medical Education and communicates changes to management. Educates Resident Coordinators on changes in Medicare regulations.

6. Identifies any potential Medicare appeals related to Medical Education. Works with legal counsel to provide support for appeals and to get administrative resolution.

7. Ensures all charging information including pricing, HCPCS codes and descriptions, revenue codes, CPT codes are current and compliant. 

8. Serves as the “reporting expert” for various financial systems for Finance and Reimbursement Develops reports and provides information as needed.

9. Assists in ensuring that the charge master is in accordance with government compliance policies and procedures, as well as third party payor needs

10. Works with revenue producing departments to ensure that all charge codes forms are submitted accurately and works with IT to verify codes have been set-up appropriately. 

11. Designs and completes weekly, monthly and annual reports used for monthly financial statements, annual Medicare Cost Reports, HCA Uniform Reports, the annual budget and external audits.

12. Maintain and continually improve on technical skills needed to manipulate and analyze data. Evaluate processes to maximize and improve efficiency in daily functions.

13. Participate in educational opportunities as provided by the hospital to enhance skill related abilities.

14. Support performance improvement and quality assurance initiatives.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, grasping and feeling are necessary body movements utilized in performing the job duties.

2. Employee may need to sit for extended periods of time.

3. Must be able to read and write legibly in English.

4. Visual acuity must be within normal range.

5. Must have hearing abilities in order to communicate effectively via telephone and in person.

6. Must have reading and comprehensive ability.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. The employee will be working in an office environment.

2. Must be able to use a keyboard, answer the telephone and use other office equipment (fax, copier, and printer).

SKILLS AND ABILITIES:

1. Good verbal and written communication skills are necessary to interact effectively with management, physicians and external auditors.

2. Analytical and interpretive skills are required along with extensive knowledge of computers and computer software systems such as Excel, Word and Access.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Day (United States of America)

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

540 SYSTEM Finance and Reimbursement