Job Details

The Reimbursement Analyst III is responsible for preparing, reviewing, and analyzing complex regulatory reports and cost filings required by Medicare, Medicaid/Medi‑Cal, and other federal and state agencies. This role supports the organization’s largest and most complex affiliates and requires demonstrated, hands‑on experience with HCAI (formerly OSHPD) reporting and Medicare Cost Report preparation.

Core responsibilities include:

• Preparing, analyzing, and validating cost reports, supplemental filings, and regulatory disclosures in accordance with CMS, Medicare, Medicaid/Medi‑Cal, and state agency requirements.
• Performing detailed review of Medicare and Medicaid/Medi‑Cal audit adjustments; managing the appeals process including preparation of supporting documentation and coordination with CMS/HCFA, HCAI, and the Department of Health Services.
• Serving as a subject matter expert on HCAI annual reporting, Medicare/Medicaid reimbursement methodologies, program regulations, and cost report implications.
• Providing financial impact analyses on regulatory changes, newly enacted or proposed legislation, and reimbursement updates; producing multi‑year projections for system and affiliate leaders.
• Supporting Managed Care negotiations by supplying reimbursement modeling, trending analyses, and regulatory insights that influence payer strategy.
• Collaborating with affiliate finance teams during contractual reviews and audits, and with external auditors or third‑party consultants on reimbursement‑related evaluations.
• Contributing to annual budget development and forecast cycles by supplying government‑payer revenue projections grounded in cost report and HCAI data.
• Ensuring accuracy, timeliness, and compliance across all submissions, internal workpapers, and supporting documentation.

Required Experience:

• Direct, recent experience preparing and filing HCAI (OSHPD) reports for large or multi‑facility healthcare organizations.
• Demonstrated experience preparing Medicare Cost Reports (e.g., Form CMS‑2552‑10) including worksheets, supporting schedules, audit follow‑up, and appeals.
• Strong knowledge of CMS reimbursement principles, Medi‑Cal reimbursement methodologies, and regulatory reporting standards.
• Advanced analytical skills with the ability to interpret complex regulatory guidance and translate it into financial impact models.