Senior Financial Government Reimbursement Analyst

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• And more

Job Summary:

• Serves as a senior technical subject matter expert responsible for the independent preparation coordination and optimization of Medicare Medicaid Tricare and other governmental cost reports and regulatory filings across the health system.
• Owns end-to-end cost report production for assigned entities - including data collection workpaper development settlement modeling and filing coordination - while interpreting and applying CMS and State Medicaid regulations to ensure compliant optimized reimbursement outcomes.
• Serves as a key liaison with Decision Support General Accounting Patient Financial Services Case Management and GME to validate data integrity and ensure accurate reporting.
• Monitors MAC correspondence settlement notices and regulatory communications.
• Supports reimbursement forecasting and reserve development through settlement modeling interim rate analysis and pass-through payment validation.

Primary duties and responsibilities:

Cost Report Preparation & Filing

• Prepare Medicare Medicaid and Tricare cost reports for assigned entities managing the full cycle from data collection and workpaper development through filing coordination.
• Interpret and apply CMS and State Medicaid regulations to ensure compliant reporting and identify reimbursement optimization opportunities.
• Support Wage Index and Occupational Mix survey preparation and filing.

Settlement Component Analysis

• Lead preparation and analysis of complex settlement components including Medicare bad debt DSH S-10 uncompensated care IME/GME organ acquisition ESRD transplant and other pass-through or supplemental payment programs.
• Validate pass-through payments and lump sum adjustments; reconcile interim rates against settled amounts.

Audit Appeals & Regulatory Defense

• Coordinate supporting documentation and audit trails required for desk reviews audits and appeals.
• Monitor MAC correspondence settlement notices and regulatory communications; coordinate responses and required documentation.
• Support audit strategy development and defend filed positions through the appeals process.

Forecasting & Financial Close

• Prepare monthly third-party settlement model supporting month-end close and reserve reporting.
• Support reimbursement forecasting and reserve development through settlement outcome modeling and interim rate change analysis.

Data Validation & Stakeholder Collaboration

• Partner with Decision Support General Accounting PFS Case Management and GME to validate data integrity and ensure accurate reimbursement reporting.
• Identify and resolve data discrepancies impacting cost report accuracy or settlement outcomes.
• Additional Duties as Assigned.

Travel:

• Less than 10% of the time may be required.

Work Type:

• Remote employee

Minimum Required Qualifications:

Education

• Bachelors degree in Accounting Finance or Business.

Experience

• 5 years minimum experience in accounting/finance with 3 years in reimbursement or cost reporting

Knowledge skills and abilities (required):

• Working knowledge of hospital patient accounting general ledger and decision support systems (Epic Strata or equivalent)
• Knowledge of pass-through payment structures lump sum adjustments and interim rate reconciliation
• Organ Acquisition 340B and IRIS experience preferred
• Ability to communicate complex reimbursement concepts clearly to finance clinical and operational stakeholders
• Experience interfacing with MACs CMS and state agencies during audits desk reviews and appeals
• Comfortable managing multiple filing deadlines and regulatory timelines simultaneously

Preferred Qualifications

Education

• Masters Degree in finance or accounting

Experience

• 7 years minimum experience with at least 5 years in reimbursement or cost reporting
  
  

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs. 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking frequent sitting Close eye work (computers typing reading writing) Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste chemicals/gases/fumes/vapors Communicable diseases Electrical shock Floor Surfaces Hot/Cold Temperatures Indoor/Outdoor conditions Latex Lighting Patient care/handling injuries Radiation Shift work Travel may be required. Use of personal protective equipment including respirators environmental conditions may vary depending on assigned work area and work tasks.

Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.