Senior Reimbursement Analyst

📋 Description

• Examine trends in third-party denials and reimbursement challenges to pinpoint root causes and suggest corrective measures.

• Lead and facilitate appeals initiatives in partnership with the Reimbursement Administrator, which includes identifying opportunities for appeals, monitoring results, and collaborating with both internal and external teams to enhance success rates.

• Perform in-depth analyses of data related to current or proposed revenue cycle projects, focusing on payor performance and denial resolution.

• Create and present findings using graphs, charts, written summaries, and presentations for review by leadership.

• Work alongside Revenue Cycle Operations to pinpoint improvement areas and aid in the execution of strategic projects.

• Support the creation and documentation of Standard Operating Procedures (SOPs) for denial management and appeals processes.

• Oversee the execution of process enhancements across the revenue cycle, ensuring they align with the organization's objectives.

• Provide timely and precise updates to management regarding outstanding denial and appeal trends utilizing established systems and tracking methods.

• Ensure prompt follow-up on unresolved issues to reduce business risks and revenue loss.

• Remain updated on payor guidelines, regulatory updates, and industry best practices pertaining to reimbursement and appeals.

• Execute additional duties as assigned.

⛳️ Requirements

• Bachelor’s Degree or equivalent professional experience.

• Over 6 years of experience in analyzing and manipulating large data sets within a healthcare revenue cycle environment.

• Advanced skills in Microsoft Excel.

• Strong understanding of payor contracts, medical terminology, commercial and government health insurance, billing guidelines, and appeals processes.

• Demonstrated analytical and critical thinking abilities.

• Familiarity with data tools such as SAS, Crystal Reports, Business Objects, or similar platforms is preferred.

• Exceptional communication and presentation skills.

• Capability to work both independently and collaboratively in a dynamic environment.

🏝️ Benefits

• Medical

• Dental

• Vision

• Life

• STD/LTD

• 401(k)

• Paid Time Off (PTO) or Flexible Time Off (FTO)

• Tuition Reimbursement

• Employee Stock Purchase Plan