Reimbursement Analyst Lead

Job Summary

The Lead Reimbursement Analyst Lead serves as the primary technical expert for the hospital’s third-party reimbursement functions. This role is responsible for the preparation and submission of complex Medicare and Medicaid cost reports, monitoring regulatory changes, and modeling the financial impact of payer contract updates. This position serves as the bridge between the Finance and Revenue Cycle departments to ensure net revenue integrity.  

Job Responsibilities

• Lead the preparation, filing, and audit defense of annual Medicare (CMS-2552) and State Medicaid cost reports.
• Perform monthly contractual allowance calculations and maintain the valuation of accounts receivable (A/R) reserves.
• Monitor federal and state legislative changes (e.g., IPPS/OPPS rulings) and calculate the fiscal impact on the hospital’s bottom line.
• Serve as the lead liaison for Medicare Administrative Contractor (MAC) audits and internal financial statement audits.
• Develop complex financial models to forecast reimbursement trends and support strategic initiatives like new service line pro formas.
• Other duties as assigned.

Education Requirements

• Minimum: Bachelor’s degree in accounting, Finance, or Healthcare Administration.

Experience Requirements

Minimum: 

• Five (5) years of experience in healthcare reimbursement or healthcare consulting.
• Advanced Excel skills (macros, Power Query) and experience with cost reporting software (e.g., HFS, HCDS) and EHR systems (Epic).

License/Certification Requirements

• Minimum:  None