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

Overview

The organization is seeking a Reimbursement Analyst to provide analytical and reimbursement-related support to operating segments across the enterprise.

• Facility: Remote (WI)
• Location: Remote, WI
• Schedule: Full time
• Weekly Hours: 40.00
• Shift: 8 Hours – Day Shifts
• Salary Range: $24.00 – $38.50

Responsibilities

• Analyze and support the implementation of new payment methodologies to establish optimal reimbursement and payment levels.
• Participate in the implementation and monitoring of reimbursement functions, including:
  • Medicare, Medicaid, or other third-party 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 negotiation and contract finalization.
• Prepare third-party payor contracts in Experian and Contract Maintenance (hospital and clinic payment integrity tools).
• Research third-party payor issues and support resolution.
• 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, including maintaining chargemasters (including setup of new codes and establishing prices).
• Assist with ongoing enterprise pricing initiatives.
• 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.
• Respond to questions and challenges regarding provided information.
• Support relationships with finance and accounting staff across the enterprise.
• Serve as a resource by providing reimbursement and accounting support.
• Review and assist in revising policies and procedures when directed.

Requirements

• Bachelor 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), and 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 insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package (eligibility varies).

Location

Remote, WI

Additional Information

• Req Number: R-0278269
• Job Function: Finance

Compliance

• EEO/AA Employer M/F/Disability/Vet.
• Drug Free Workplace Policy: an accepted offer requires a drug screen and pre-employment background screening as a condition of employment.