Reimbursement Specialist II
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.
The Reimbursement Specialist II is responsible for managing, analyzing, and ensuring the accuracy and timeliness of Medicare cost report acceptance, settlements, interim rates, and applicable limits for healthcare providers within the Fiscal Intermediary Shared Systems (FISS). This role plays a critical part in ensuring proper reimbursement and compliance with Medicare regulations while working closely with internal teams and external stakeholders.
Worksite:
- Remote, U.S.
- This position is full-time (40-hours/week) Monday-Friday
Key Responsibilities
Cost Report & Reimbursement Analysis
- Conduct in-depth analysis of Medicare cost reports to complete tentative and straight-to-final settlements and rate reviews.
- Evaluate payment rates for PPS providers receiving pass-through payments, RHC per-visit limits, and per diem rates for cost-reimbursed providers.
- Review and validate financial documents, including system-generated reports, provider-submitted work papers, PS&R reports, and lump sum data.
Regulatory Compliance & System Updates
- Ensure compliance with CMS (Centers for Medicare & Medicaid Services) regulations, monitoring CMS directives (TDLs, CRs, and other official guidance) to implement necessary updates.
- Review and process status changes for Sole Community Hospitals, rural reclassifications, and rural referral centers.
- Work closely with CMS and internal teams to submit and recommend accelerated payment requests for providers facing financial hardships.
Operational Management & Process Improvement
- Track and prioritize provider-requested reviews outside of normal workload cycles.
- Maintain and update internal workflow processes, system configurations, and procedural documentation in response to CMS requirements.
- Analyze and address discrepancies in workload reports, ensuring timely completion of daily and monthly tasks.
Collaboration & Training
- Work closely with internal teams, including Reimbursement Staff, Supervisors, and Managers, to coordinate CMS correspondence and regulatory updates.
- Provide mentorship and training on specialized reimbursement functions and system usage.
- Develop and deliver training programs to enhance team expertise in cost report processing and enrollment updates.
Qualifications & Experience
Required Qualifications:
- Associate’s degree in Accounting, Business, or a related field.
- 3+ years of experience in Medicare cost report processing, reimbursement functions, enrollment updates, and provider payments.
- Strong analytical skills with exceptional attention to detail and a high level of accuracy.
- Ability to interpret and apply Medicare regulations and reimbursement principles.
- Critical thinking and problem-solving abilities in a healthcare reimbursement setting.
- Proficiency in Microsoft Office Suite (Excel, Word, Access, PowerPoint) and data analysis tools.
Preferred Qualifications:
- Bachelor’s degree in Accounting, Business, Healthcare Administration, or a related field.
- Medicare Cost Reporting experience, with advanced knowledge of Medicare Cost Reporting systems, FISS, Higlas, STAR, and WPM.
- 2+ years of experience in accounting or healthcare reimbursement.
- Excellent time management, organizational, and customer service skills.
Why Join Us?
- Impactful Work: Contribute to Medicare compliance and provider reimbursement, ensuring proper healthcare funding.
- Professional Growth: Gain exposure to complex reimbursement models and regulatory compliance in a dynamic healthcare environment.
- Collaborative Team: Work with industry experts in a supportive, team-oriented culture.
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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