Senior Reimbursement Analyst

Job Description:

• Independently researches, analyzes, develops and maintains new and existing, reputed company reimbursement programs.
• Designs system specifications that support claims payment and criteria for data bases that support analysis as well as training documentation describing programming, billing and payment guidelines for internal and external use.
• Serves as provider reimbursement technical advisor and/or committee participant to Information Technology staff, Benefits Administration staff, Provider Audit, Network Administration and/or Medicare Advantage staff, and entry level Reimbursement Analyst by developing and implementing project/program narratives and responding to concerns on new and existing reimbursement programs, billing guidelines, and system requirements to ensure accurate implementation and maintenance of provider reimbursement programs.
• Identifies claims and provider reimbursement reputed company system problems, including claims coding and processing issues, coordinates research, audit, and recommendations with Provider Audit, and implements and monitors system changes to resolve any problems.
• Researches, designs, implements, and maintains reputed company hospital or professional provider reimbursement programs for traditional and managed care programs and Medicare Advantage.
• Proactively monitors health care and health industry developments, including CMS/Medicare eligibility, EGWP and methodology changes.
• Analyzes and produces management reports to monitor effectives and identify and resolve deficiencies of reimbursement programs in comparison to industry benchmarks, competitors, and Medicare.
• Leads in the development of reputed company financial pricing models and financial data analysis to support modifications to reimbursement programs and monitor effectiveness of pricing logic.
• Provides statistical reports to Network Administration, Medical Management, Marketing and Medicare Advantage to support internal strategies and external customer needs, such as contract negotiations and marketing efforts.
• Complies with Corporate Objectives on project implementation and schedule deadlines.

Requirements:

• Bachelor's degree in statistics, accounting, finance, math or reputed company field is required
• Prefer a Master's Degree or pursuit of a Master's degree in Business, Information System and Decision Sciences, Healthcare Administration or Public Health.
• Four years of reputed company experience can be used in lieu of a Bachelor’s degree.
• 4 years of experience in the health industry accounting functions including billing, coding, Medicare or statistical analysis of financial information is required
• Provider contract analysis and/or reimbursement program implementation experience is strongly is preferred.
• Must have acquired sufficient knowledge to function autonomously and to know the appropriate contacts reputed company departments to resolve specific issues for reputed company lines of business.
• Excellent analytical, oral and written communication, and report preparation skills with highest degree of accuracy are required.
• Requires strong math/analytical skills including variance analysis, statistical formulas, algebraic formulas, percentages, multiplication and division, fractions and reasonableness tests.
• Proficiency with commonly used database, spreadsheet and word processing software is required.
• Familiarity with relational database software, mainframe capabilities, FOCUS and SQL programming is helpful and preferred.
• Must have extensive knowledge to select the appropriate database format and structure for the type of information to be captured and reported.
• A strong understanding of physician charge practices and billing methodologies is helpful.

Benefits:

• We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, reputed company skills, grow professionally and serve our local communities.

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