Govt Reimbursement Analyst

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

9/1/2021

Entity:

Wisconsin

Job Code:

440072

Job Title:

Govt Reimbursement Analyst

Exemption Status:

Exempt

Management Level:

Individual Contributor

JOB SUMMARY

The Government Reimbursement Analyst is responsible for performing a wide variety of financial reporting, modeling, and related analyses for UW Health's government and non-government payors.  The governmental programs consist of Medicare, Wisconsin Medicaid, Illinois Medicaid, various other Medicaid programs, and CHAMPUS.   These governmental programs are responsible for a large portion of UW Health's net patient revenue budget and produce the largest and most consistent Balance Sheet operating cash flows.

The governmental programs involve numerous complexities and require voluminous financial and statistical data synthesized under cost reporting principles.  Both the Federal and State governments mandate cost reporting.  The incumbent is expected to analyze and interpret regulations on a continuing basis. This position will also prepare and review general ledger information, compile and prepare financial reports, and may assist in annual budgetary procedures.  The Reimbursement Analyst will analyze and evaluate existing data processes and interfaces with the Patient Accounting system, Cost Accounting system, General Ledger and Statistical reporting systems.

MAJOR RESPONSIBILITIES

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Performs comparative general ledger account analysis: analyzes cost and revenue variances. Performs revenue, cost, and payment analysis. Completes the monthly balance sheet contractual analysis to ensure the accuracy of identified contractual allowances. Recommend monthly changes to the balance sheet as appropriate.

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Analyzes and evaluates UW Health accounting interfaces to the cost reporting systems. Evaluates reporting and determines if changes are necessary to create industry best practices. Performs analysis to support reclassification adjustments and GAAP vs. cost reporting variances.

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Reviews and keeps up to date on Healthcare reform changes and proposals. Understands the proposed changes and what affect they will have on Federal and State reimbursement to UW Health.

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Provides analytical interpretation and substantiation during the UW Health annual financial audit and the annual governmental audits by CMS, the State of Wisconsin and State of Illinois. This will include responding to auditor inquiries, analyzing calculations, interpreting cost report justifications, re-opening previously audited cost reports, and handling audit appeals and disputes.

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Analyzes, designs and implements program specific reports for specialty reimbursed areas. Recommends new processes and ways to ensure maximum reimbursement capture for these areas, these areas include but are not limited to: disproportionate share reimbursement, medical education, Medicare bad debts, organ acquisition, organ sales and other disposition of organs.

ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS.

X

Non-Clinical

JOB REQUIREMENTS

Bachelor's Degree

In Accounting, Finance, Business or another related field

Required

Four (4) years of relevant finance or accounting experience may be considered in lieu of the degree in addition to the experience below

4 years

of experience in accounting or finance that includes experience with computer systems, spreadsheet and database applications, data flow, report creation, and data interpretation

Required

Previous experience in hospital reimbursement activities, preferably at an academic medical center or with a Medicare Administrative Contractor or a State Medicaid Agency

Preferred

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Knowledge of Generally Accepted Accounting Principles and governmental regulations as applied to modern health care financial management

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Knowledge of the principles of statistical analysis as applied to the development and design of financial reporting

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Thorough knowledge of and experience in financial system applications and software

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Experience in database development and management

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Experience in Microsoft Office Suite (Excel, Access, Word, Outlook)

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Ability to work effectively and independently managing tasks in a fast-paced environment

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Excellent written and verbal communication skills

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Analytical and problem-solving abilities with the ability to manipulate and understand complex information

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Effective organizational and time management skills with proven ability to meet deadlines

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Knowledge of both Federal and State governmental healthcare programs specific to reimbursement rules and regulations

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

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Sedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be negligible amount, a job is in this category when it requires walking or standing to a significant degree.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

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Medium: Ability to lift up to 50 pounds maximum with frequent lifting and/or carrying objects weighing up to 25 pounds.

20-50#

10-25#

Negligible-10#

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Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.

50-100#

25-50#

10-20#

☐

Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.