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Reimbursement Specialist II

United States - Remote

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

Job Summary


The Reimbursement Specialist II is responsible for the management, analysis, accuracy, and timeliness of Medicare cost report acceptance, tentative and straight-to-final settlements, Medicare interim rates, and applicable limits for all providers in the Fiscal Intermediary Shared Systems (FISS). This position ensures the proper reimbursement for Medicare healthcare providers and includes advanced duties beyond the Reimbursement Specialist I level.

Key Responsibilities

  • Analyze cost report data to complete tentative and straight-to-final settlements and rate reviews
  • Review payment rates for PPS providers receiving pass-through payments, RHC per visit limits, cost-reimbursed provider per diem rates, and providers on PIP
  • Prepare and analyze documentation supporting final interim rates, including system screen prints, provider-submitted workpapers, PS&R reports, lump sum data, and supervisor-approved cover sheets
  • Respond to provider inquiries regarding rates and reimbursement issues
  • Monitor and manage daily and monthly workload reports/logs to ensure timely completion
  • Research and resolve discrepancies in workload items
  • Prioritize provider-requested reviews outside of normal workload cycles
  • Interpret, implement, and monitor CMS correspondence to assess impact on reimbursement processes and workloads
  • Track and meet deadlines for CMS Correspondence, including task assignments and feedback
  • Collaborate with reimbursement staff, team supervisors, and managers to ensure CMS Correspondence items are addressed; communicate with CMS and Noridian inter-department staff
  • Update and adjust internal processes based on CMS directives such as TDLs and CRs
  • Review status changes for Sole Community Hospitals, rural reclassifications, and rural referral centers
  • Ensure timely submission of accelerated payment requests to CMS on behalf of providers with special payment needs
  • Create, contribute to, and deliver training on specialized reimbursement functions
  • Maintain a deep and comprehensive understanding of cost report processing and enrollment updates

Required Qualifications

  • High school diploma or GED
  • Associate’s Degree in Accounting or Business-related field, or equivalent work experience
  • 3 years of applicable experience in customer service, general office, accounting, or healthcare
  • 1 year of experience in accounting, or healthcare
  • Accurate data entry and strong problem-solving skills
  • Advanced knowledge of cost report processing, including reimbursement functions, enrollment updates, and payments

Preferred Qualifications

  • Bachelor’s Degree in Accounting, Business, or a related field (as determined by HR)
  • 2 years of experience in accounting or healthcare
  • Medicare cost reporting experience
  • Advanced proficiency in Medicare cost reporting systems, including FISS, Higlas, STAR, and WPM
  • Familiarity with Medicare regulations and reimbursement principles
  • Proficient with Microsoft Office applications including Word, Excel, Access, and PowerPoint
  • General knowledge of healthcare systems and practices
  • Effective verbal and written communication skills
  • Excellent time management, attention to detail, and analytical thinking
  • Strong organizational skills and ability to multi-task

Benefits: 

  • 401(k) 
  • 401(k) matching 
  • Dental insurance 
  • Disability insurance 
  • Medical insurance 
  • Life insurance 
  • Flexible Paid time off (FPTO) 
  • Paid Holidays 

 

 

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting.

Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

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