Reimbursement Analyst

Overview

This position offers the opportunity to lead and contribute to Provider Network Economics initiatives that influence reimbursement strategy, provider partnerships, operational performance, and organizational financial results. The role provides exposure to senior leadership, extensive cross-functional collaboration, and the ability to shape innovative payment models supporting high-quality, affordable healthcare.

Remote work is available.

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

Responsibilities

• Provide analytical and reimbursement-related support to operating segments across the organization.
• Analyze and implement new payment methodologies to establish optimal reimbursement and payment levels.
• Participate in implementations and monitoring of reimbursement functions, including:
  • Medicare, Medicaid, and 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.
• Support impact analysis of payor contract changes during negotiations and 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 team in maintaining chargemasters, particularly for new code setup and price establishment.
• Assist with 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 useful and understandable formats; respond to questions and challenges regarding provided information.
• Support relationships with finance and accounting staff across the enterprise.
• Serve as a resource for 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), including 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
• Full-time and part-time employees may be eligible for a benefits package that includes:
  • Health, dental, vision, and life insurance
  • 401(k) retirement plan
  • Work/life balance benefits
  • A generous time off package

Location

• Remote, WI (Facility: Remote WI)