Senior Reimbursement Analyst - (Pricing and Charge Maintenance)

This position plans, designs, develops and maintains an extensive support system for all Sutter Health affiliates and/or associates including (a) Acute Hospitals, (b) Psychiatric Hospitals, (c) Rehabilitation Units, (d) Home Health Agencies, (e) Skilled Nursing Facilities, (f) Rural Health Clinics. Prepares, completes, and submits the annual Medicare and Medi-Cal compliance Cost Reports with all the required supplemental schedules. Functionally supervises by directing, reviewing, training, and developing the Reimbursement Analyst's work and skills in a positive professional manner. Reviews all Medicare and Medi-Cal audit adjustments, initiating, and following up any appeal process with HCFA and DHS. Interacts with Medicare and Medi-Cal Auditors, both internal and outside legal counsel, facility Administrators, CFOs, Controllers, and other management support staff; therefore it is incumbent upon this position to maintain good professional working relations. Also provides support to (a) management personnel during the budget process, (b) Managed Care Dept. personnel during the negotiation process, (c) Sutter Health entities monthly and yearly contractual reviews, (d) provide third party reimbursement analysis, and (e) provide system and affiliate management with multi-year projections on government payer revenues based on newly enacted or proposed legislation. Education : A Bachelor's Degree in Accounting, Finance, Healthcare Administration, Information Technology or related field is desired. The equivalent combination of certifications, training, and 5 -10 years experience may be considered. Epic certification or proficiency in Hospital Billing and Clarity is preferred.

Experience : Experience in healthcare to have developed extensive knowledge in the proper application, compliance and treatment of health care operational activities, Medicare and Medi-Cal Laws and Regulations governing facility entitlements under Title XVIII and Title XXII as is typically obtained in 5-7 years. In addition, experience required for this position includes the following: * Demonstrated ability to read, research, interpret and implement government laws and regulations and changes thereof. * Must have demonstrated experience in the preparation and completion of Medicare and Medi-Cal Cost Reports. * Must have the ability to coordinate and work with Medicare and Medi-Cal Auditors, as well as be knowledgeable in both Medicare and Medi-Cal audit and appeal processes. * Must have demonstrated experience in preparing Medicare and Medi-Cal audit appeals position papers and documentation that meets all requirements as stipulated by Medicare and Medi-Cal regulations governing the Appeal Procedures. * Must have directed the preparation of the annual Medicare and Medi-Cal cost report, and the California Annual Hospital Financial Disclosure Report (OSHPD) * Must be knowledgeable and have performed and/or developed calculations of contractual allowance amounts recorded in the Hospital's general ledger. * Required to have performed routine pricing reviews to identify issues and areas for improvement * Required ability to identify financial impact of price adjustments * Required experience in collecting and reviewing data points, including hospital-specific average line item level charges, room rates, average DRG charges, adjusted case mix index data, departmental RCCs, undated CMS guidelines, and any other applicable comparative pricing data points * Preferred experienced in process improvement and have the ability to identify and minimize process variation * Required to have the ability to compile periodic reports with metrics by service line and/or hospital service, detailing issue category, frequency, cause, preventive recommendations and trends * Required to provide expertise and guidance in the pricing of new procedures, price changes and pricing variation and methodologies * Required to perform assessments of affiliate prices compared to the other healthcare providers and industry standards * Required to have the ability to review data quality across multiple data repositories, including spreadsheets, spreadsheet formulas and SQL Server tables

Knowledge : * Must be knowledgeable and thoroughly understand the various Medicare and Medi-Cal cost reporting and compliance requirements. * Must be knowledgeable in both old and current Medicare and Medi-Cal Laws and regulations governing reimbursement related to Acute Hospitals, Psychiatric Hospitals, Rehabilitation Unit, Skilled Nursing Facilities, Rural Health Clinics, Inpatient and Outpatient pay system, Medi-Cal payment system and regulations under Title XXII. * Must be knowledgeable and understand the California Annual Hospital financial Disclosure reporting process and requirements. * Must have thorough knowledge of the hospital accounting system, audit processes, workpapers presentation, computer skills, and automated Medicare/Medi-Cal cost report software. * Must be knowledgeable in the use of personal computer and its applications, such as: spreadsheet, word-processing, and cost reporting software application. * Must be proficient and know how to write brief and concise reports. * Must be knowledgeable in creating and developing workpapers with supporting documents to establish audit trails to support cost report data. * Must know and understand how to apply statistical methods. * Must be able to perform and complete work assignments effectively and accurately with very minimal direction and supervision.

* Preferred complete knowledge and understanding of pricing methodologies for Supplies, Pharmacy, and all other CDMs * Required exceptional understanding of healthcare data such as CPT codes, revenue codes, hospital billing, OSHPD and CMS(Medicare) * Required must have a comprehensive knowledge of healthcare operations continuum, and Finance and Revenue Cycle processes, reimbursement and managed care contracting, financial impact analysis including Gross and Net Patient Service Revenue, etc. Special Skills/Equipment : * Must have excellent organizational, analytical and planning skills. * Must have demonstrated leadership, adult training and education skills. * Must have ability to determine reasonableness of data acquired from various sources. * Must have excellent written, verbal and interpersonal and presentation skills. * Must be able to work with all levels of management and translate complex rules and regulation issues, requirements to non-reimbursement staff at the facility level. * Must have the ability to constantly maintain a professional working relationship with various personnel during difficult situations. * Must possess the skill to negotiate and persuade when needed. * Must have the ability to handle shifting priorities and multiple projects independently and simultaneously. * Must be able to work independently with very minimum supervision. * Must have the ability to read and interpret government regulations. * Must have the ability to work on various assignments (example: 3-5 hospital cost reports at one time) and adhere to critical deadlines. * Must be knowledgeable and proficient in the use of Personal Computers, spreadsheets and word-processing software, and cost report software * Must have a valid California Drivers License.

* Required to have advanced Excel skills with a robust knowledge of advanced table and graph/charting functions * Preferred experience with SQL and knowledge of SQL Server Databases * Experience in Charge Capture systems such as OPTime, Williow, Radiant, and Lynx * Required to have the ability to process large volumes of data for analysis (cleansing, modifying, and formatting) and mapping data across various systems * Required to have exceptional communication and presentation skills with experience presenting to all levels of a health system

Physical Requirements: * Must be able to sit and work at a computer for extended periods of time (5-8 hours daily). * Must be able to travel throughout Northern California with some overnight stays out of town. * Must be able to adapt and work in areas while working on-site at the facility. * Must be able to lift weights (5-30 lbs.) to carry workpapers files, retrieve various documents.