Senior Managed Care Reimbursement Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with Facility Information Systems and Health Information Management to extract data for continuous analysis of account-based reimbursement transactions.

• Evaluate Facility Managed Care contracts and reconcile them with received payments.

• Provide recommendations to avert future cash losses.

• Assist in reimbursement strategies and initiatives by analyzing performance objectives.

• Assess modifications for transitioning from fee-for-service reimbursement to risk-based reimbursement/capitation.

• Oversee reports that monitor discrepancies between managed care contracts.

• Compare anticipated reimbursement rates by site and service, benchmarking against other payment rates, including Medicare.

• Create financial and planning models for reimbursement initiatives, contracts, amendments, payment disputes, regulatory changes, and provider manual updates.

• Conduct reimbursement modeling for strategic projects, services, and managed care contract scenarios.

• Execute strategic reimbursement modeling to support alterations in charge master.

• Access rate schedules, product information, and historical claims to develop and implement model scenarios.

• Integrate data, opportunities, issues, and challenges; clearly communicate findings, conclusions, and recommendations.

⛳️ Requirements

• Bachelor’s Degree in Business, Statistics, Information Systems, Healthcare Management, or a related field — Required.

• Master’s Degree in Business, Statistics, Information Systems, Healthcare Management, or a related field — Preferred.

• Minimum of 7 years of experience in Reimbursement/Analyst roles — Required.

• At least 5 years of experience in Healthcare Managed Care Modeling — Required.

• EPIC Certified or Accredited; EPIC certification must be obtained within 180 days — Required.

• Travel requirement: Never or Rarely.

🏝️ Benefits

• Comprehensive benefit offerings available for eligible employees.

• Travel requirement is never or rarely.