Sr. Reimbursement Analyst - Clinic

Summary

Duties involve all aspects related to compliance with governmental rules and regulations regarding the implementation and ongoing operations of the Provider Based Billing Clinics (PBB), Rural Health Clinics (RHC), National Health Service Corp (NHSC), Michigan Loan Repayment (MSLRP), and Joint Commission (JC). This position is responsible for program coordination that addresses the regulations and guidelines to assure high quality of care and realize funding levels through payments received by participation in programs. This position provides oversite services to help managers, worksite supervisors, providers and staff navigate program regulations. Coordination occurs across care settings and across the Health System.

Responsibilities

(75%)* Demonstrate competence to effectively develop, implement and maintain system-wide PBB, RHC, NHSC, MSLRP, and JC statuses based on government regulations, guidelines and requirements while maintaining positive working relationships with key stakeholders (providers, staff, administrators, support agencies). This includes the following CMS requirements: • Location-Specific NPI – distinct from main hospital campus, apply for organizational (Type 2) NPI and update corresponding Medicare enrollment filings (CMS-855a) to reflect new identifiers for each off-campus site. • Initial Attestation Filing – submit attestation to the Department of Health and Human Services secretary for parent hospital that the off-campus department satisfies every element of the PBB criteria within rolling two-year period ending on the date services are furnished, refreshing/replacing older filings as needed. • Periodic Renewal – file subsequent attestations within the timeframe specified by the Secretary (a recurring compliance cycle) for each covered location. (15%)* Provide ongoing support for reimbursement-related initiatives and proactively recommend improvements to workflows, policies, and procedures to enhance operational efficiency and compliance. (10%)* Assist with preparation of accurate and timely workpapers specifically related to clinics financial data and analysis. Utilize multiple systems and data sources to gather, analyze and validate required information throughout the preparation process.

Certifications and Licensures

Equivalent Experience -

Required Education

Education: BACHELORS DEGREE

Comments: Bachelor's Degree in Finance, Business Administration or related field required.

Other Information

EXPERIENCE, TRAINING AND SKILLS: Experience in healthcare reimbursement and financial functions a minimum of three years (3). Demonstrate competence relating to implementation and maintenance of PBB and RHC status, data analysis, cost reporting, process improvement, and revenue cycle optimization. Demonstrate completion of governmental forms e.g. applications, licensure, cost reports. Collaborate in goal setting and help identify issues and barriers. Identify and interpret results of program evaluations. Assist in program communication. Demonstrate knowledge and expertise in area of responsibility by participation in program areas.

 

Demonstrate competencies in PBB/RHC reimbursement and encourage development of skills in the physician office staff. MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft®

Equivalent Experience and Other Comments (Education)

PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS: Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death. Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position. Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description. Overall vision and hearing is necessary with or without assisted device(s). Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching. Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required. Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake. Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis. Physical Demand Level: Light. Must be able to occasionally (0-33% of the workday) lift or carry 11-20 lbs., frequently (34-66% of the workday) 10 lbs. and or Walk/Stand/Push/Pull of Arm/Leg controls.

Other Comments

Reports to Manager Reimbursement

EXPERIENCE, TRAINING AND SKILLS: Experience in healthcare reimbursement and financial functions a minimum of three years (3). Demonstrate competence relating to implementation and maintenance of PBB and RHC status, data analysis, cost reporting, process improvement, and revenue cycle optimization. Demonstrate completion of governmental forms e.g. applications, licensure, cost reports. Collaborate in goal setting and help identify issues and barriers. Identify and interpret results of program evaluations. Assist in program communication. Demonstrate knowledge and expertise in area of responsibility by participation in program areas.

 

Demonstrate competencies in PBB/RHC reimbursement and encourage development of skills in the physician office staff. MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft®

(75%)* Demonstrate competence to effectively develop, implement and maintain system-wide PBB, RHC, NHSC, MSLRP, and JC statuses based on government regulations, guidelines and requirements while maintaining positive working relationships with key stakeholders (providers, staff, administrators, support agencies). This includes the following CMS requirements: • Location-Specific NPI – distinct from main hospital campus, apply for organizational (Type 2) NPI and update corresponding Medicare enrollment filings (CMS-855a) to reflect new identifiers for each off-campus site. • Initial Attestation Filing – submit attestation to the Department of Health and Human Services secretary for parent hospital that the off-campus department satisfies every element of the PBB criteria within rolling two-year period ending on the date services are furnished, refreshing/replacing older filings as needed. • Periodic Renewal – file subsequent attestations within the timeframe specified by the Secretary (a recurring compliance cycle) for each covered location. (15%)* Provide ongoing support for reimbursement-related initiatives and proactively recommend improvements to workflows, policies, and procedures to enhance operational efficiency and compliance. (10%)* Assist with preparation of accurate and timely workpapers specifically related to clinics financial data and analysis. Utilize multiple systems and data sources to gather, analyze and validate required information throughout the preparation process.