Overview

The Senior Cost Accountant is a key member of the Cost Accounting team within Financial Planning & Analysis, reporting directly to the Director of Cost Accounting. This role is responsible for executing and maintaining the health system’s cost accounting models, performing detailed cost and margin analyses, and supporting service-line profitability reporting. The Senior Cost Accountant partners with finance, clinical operations, and department leaders to deliver accurate, timely cost intelligence that drives operational and strategic decision-making.

Responsibilities

Cost Accounting Operations

• Maintain the enterprise cost model and allocate direct and indirect costs across departments, service lines, procedures, and episodes of care.
• Perform recurring standard costing, activity-based costing (ABC), and cost-to-charge ratio (RCC) analyses.
• Reconcile cost model results to the general ledger and resolve variances with finance and accounting teams.
• Support cost accounting system implementation, configuration, and optimization.
• Maintain cost center mappings, charge master alignment, and allocation drivers.

Financial Analysis and Reporting

• Conduct profitability and contribution margin analyses across procedures, DRGs, physicians, payers, and service lines.
• Prepare annual costing books to support budgeting, pricing, and contract negotiations.
• Analyze variances between actual, standard, and budgeted costs.
• Develop dashboards and recurring reports to provide cost and margin insights.
• Perform ad hoc analyses to support strategic, operational, and capital planning decisions.

Compliance and Data Integrity

• Assist with Medicare and Medicaid cost reporting and CMS compliance requirements.
• Ensure accuracy and integration of cost data across financial and clinical systems.
• Support internal and external audits by providing required documentation and analysis.
• Benchmark costs against industry peers and present findings to leadership.

Collaboration and Process Improvement

• Partner with finance, clinical, and supply chain teams to identify cost drivers and savings opportunities.
• Recommend and implement improvements to enhance cost accounting processes and efficiency.
• Mentor junior analysts on cost accounting principles and best practices.
• Represent cost accounting in cross-functional initiatives, including system implementations and value-based care projects.

Qualifications

• Minimum Qualifications

  Education

  • Bachelor’s degree in Accounting, Finance, or a closely related field (required).
  • Master’s degree in Accounting, Finance, Business Administration (MBA), or Healthcare Administration (MHA) – (preferred)

  Certifications

  • CPA (Certified Public Accountant) or CMA (Certified Management Accountant) (preferred)
  • HFMA (Healthcare Financial Management Association) certification a plus.

  Experience

  • Minimum of 5 years of progressive experience in cost accounting, financial analysis, or management accounting, with at least 3 years in a healthcare setting.
  • Direct experience with healthcare cost accounting systems (e.g., Strata Decision Technology, Axiom, or similar).

  Preferred Qualifications

  • Working knowledge of activity-based costing, RCC methodologies, and clinical cost benchmarking.
  • Experience with Epic EHR and PeopleSoft or similar ERP platforms.
  • Familiarity with DRG-based reimbursement, APCs, value-based payment models, and bundled payment programs.
  • Proficiency in Excel (advanced formulas, pivot tables, macros), SQL, and data visualization tools (e.g., Tableau, Power BI).
  • Experience supporting payer contract analyses or physician compensation modeling.
  • Experience with Medicare and Medicaid cost report data and CMS regulatory requirements.
  • Experience in an academic medical center or large multi-hospital health system preferred.