Reimbursement Analyst, Health Plan - ND, SD, MN, WI

Overview

This role provides analytical and reimbursement support to operating segments across the organization’s enterprise. Responsibilities focus on reimbursement strategy, provider network economics, and the implementation and monitoring of payment methodologies that influence reimbursement strategy, provider partnerships, operational performance, and organizational financial results.

Remote work is available.

• Facility/Location: Remote, MN
• Shift: 8 hours – Day shifts
• Schedule: Full time (40.00 hours/week)
• Salary range: $24.00 - $38.50

Responsibilities

• Provide reimbursement-related analytical support to operating segments across the enterprise.
• Assist with analyzing and implementing new payment methodologies to establish optimal reimbursement and payment levels.
• Participate in implementation and monitoring of reimbursement functions, including:
  • Medicare and Medicaid cost reports
  • Related audits and appeals
  • Disproportionate Share Hospital (DSH) programs
  • Drug discount programs (340B)
  • CPT/HCPCS code changes
• Prepare impact analysis of payor proposed and final Medicare and Medicaid regulation changes.
• Assist with impact analysis of payor contract changes during negotiations and contract finalizations.
• Prepare third-party payor contracts in Experian and Contract Maintenance (hospital and clinic payment integrity tools).
• Research third-party payor issues.
• Support annual pricing and fee schedule updates, including impacts on physician compensation.
• Assist with annual budgeting and audit processes, including monthly discounts, year-end discounts, and third-party reserves.
• Provide ongoing support to operations and CDM teams in maintaining chargemasters, including setup of new codes and establishing prices.
• Support ongoing pricing initiatives across the enterprise.
• Produce reports, analyze and integrate data, and complete other projects accurately and efficiently.
• Maintain integrity and confidentiality of data when sharing with others.
• Prepare data in a useful and understandable format, and respond to questions and challenges regarding provided information.
• Support relationships with finance and accounting staff across the enterprise.
• Serve as a resource for individuals while providing reimbursement and accounting support.
• Review and assist in revising policies and procedures when directed.

Qualifications

• Bachelor’s degree required in business administration, finance, healthcare management, information technology (IT), or related field.
• Minimum two years of related work experience, preferably in hospital, clinic, or insurance finance and/or managed care reimbursement.
• Demonstrated knowledge and experience in health care reimbursement related to:
  • claim editing
  • groupers
  • provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS)
  • industry standard coding and payment rules
• Minimum one year of related work experience, preferably in hospital, clinic, or insurance finance and/or managed care reimbursement.

Compensation & Benefits

• Salary range: $24.00 - $38.50
• Qualifying full-time and part-time employees may be eligible for benefits including:
  • health, dental, and vision insurance
  • life insurance
  • a 401(k) retirement plan
  • work/life balance benefits
  • a generous time off package

Location

Remote, MN