Reimbursement Analyst

This is a fully remote position, open to applicants in North Dakota, +3 more states.

📋 Description

• Evaluate and implement innovative payment methods to ensure optimal reimbursement and payment levels.

• Engage in the implementation and oversight of reimbursement processes, including Medicare, Medicaid, third-party cost reports, audits, appeals, DSH programs, 340B drug discount programs, and changes in CPT/HCPCS codes.

• Compile impact assessments for proposed and finalized changes in Medicare and Medicaid regulations.

• Analyze modifications to payor contracts during negotiation and finalization stages.

• Draft third-party payor contracts using Experian and manage Contract Maintenance.

• Investigate issues related to third-party payors.

• Assist in the annual updates of pricing and fee schedules, considering the impacts on physician compensation.

• Contribute to the annual budgeting and auditing processes.

• Collaborate with operations and CDM teams to maintain chargemasters and establish new codes and pricing.

• Generate, assess, and integrate data for various projects and reports.

• Foster finance and accounting relationships throughout the organization.

• Offer reimbursement and accounting support, acting as a knowledgeable resource.

• Review and help revise policies and procedures.

⛳️ Requirements

• A Bachelor’s degree in business administration, finance, healthcare management, information technology (IT), or a related discipline is required.

• At least two years of relevant work experience, preferably in the finance of hospitals, clinics, or insurance and/or managed care reimbursement.

• A minimum of one year of related work experience in hospital, clinic, or insurance finance and/or managed care reimbursement is preferred.

• Proven knowledge and experience in healthcare reimbursement, particularly regarding claim editing, groupers, provider reimbursement, and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS).

• Familiarity with industry-standard coding and payment regulations.

• Exceptional attention to detail is essential.

• Ability to uphold the integrity and confidentiality of data.

• Proficient in preparing data in a clear and comprehensible format.

🏝️ Benefits

• Flexible remote working options.

• Emphasis on work-life balance.

• Opportunity to engage with senior leadership.

• Extensive collaboration across various functions.

• Opportunities for growth and continuous learning.