Senior Reimbursement Analyst

This is a fully remote position, open to applicants in North Carolina.

📋 Description

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

• Spearhead and assist appeals initiatives in collaboration with the Reimbursement Administrator, including recognizing appeal opportunities, monitoring outcomes, and partnering 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 reports, and presentations for review by leadership.

• Work alongside Revenue Cycle Operations to pinpoint areas for enhancement and facilitate the execution of strategic initiatives.

• Aid in the creation and documentation of Standard Operating Procedures (SOPs) for denial management and appeals workflows.

• Oversee the execution of process enhancements throughout the revenue cycle, ensuring they align with organizational objectives.

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

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

• Remain updated on payor guidelines, regulatory developments, and industry best practices concerning reimbursement and appeals.

• Undertake additional duties as assigned.

⛳️ Requirements

• A Bachelor’s degree with 7 years of experience in Healthcare Billing Systems and Payor and Policy knowledge along with advanced analytics, or an Associate’s degree with 9 years of relevant experience, or a High School diploma or GED with 11 years of experience in the same fields is required.

• A minimum of 5 years of experience with payor contracts, medical terminology, commercial and government health insurance, billing guidelines, and appeals processes.

• At least 3 years of experience with SAS, Crystal Reports, Business Objects, or similar reporting platforms.

• 5 or more years of advanced proficiency in Microsoft Excel (including formulas and pivot tables).

🏝️ Benefits

• Medical

• Dental

• Vision

• Life

• STD/LTD

• 401(k)

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

• Tuition Reimbursement

• Employee Stock Purchase Plan