Reimbursement Analyst

The Reimbursement Analyst has responsibility for development and optimization of reporting and analysis for contract performance, reimbursement trends, payer policy changes, and financial performance. This position will work within the Finance team to develop tools for data collection for payment models and trends and analyze their financial impact on the organization. This position will monitor changes in payer contracts and guidelines, for both commercial and commercial payers, to educate and act as a resource for the organization and assist in implementation of changes.

Essential Job Functions

• Assists with preparation of reports and report analysis for reimbursement and utilization issues. Completes financial analysis regarding reimbursement and compliance issues or opportunities.
• Monitors all changes to payer contracts and payer guidelines to provide education to appropriate staff prior to changes to ensure timely implementation of upcoming changes.
• Analyzes payer reimbursement calculations and charges to validate payments from government and commercial payers to ensure compliance with billing and coding guidelines. Assists with development and analysis of contract proposals and performance. Works with third party payers to address any payment discrepancies or billing issues.
• Develops and maintains expert level of knowledge on risk scoring, episodes of care, bundled payments and other industry specific trends in reimbursement methodology.
• Summarizes data and findings for internal and/or external audiences. Creates graphical data, written reports, and/or statistical analysis to explain trends and opportunities.
• Performs research and stays up to date regarding all third party and government payer rules, regulations, and payment policies. Assists with communication and education with appropriate staff to ensure compliance with changes. Monitors trends for inpatient, outpatient, and physician billing, coding and payment methodology.
• Assists in preparation of reporting for Medicare cost report. Develops and maintains expert level of knowledge of Medicare guidelines, reimbursement methods and cost report.
• Performs internal audits to ensure billing compliance and optimal reimbursement. Performs department specific analysis of charges to determine correct charges are being utilized. Works with staff to correct trending issues and discrepancies and determine any opportunities for process improvements in billing, strategic pricing, and documentation. Performs research and analysis for new and updated procedures to ensure billing and coding compliance.

Education & Experience

Bachelor's Business Or Bachelor's Related Field Required

A minimum of 1 year of related experience