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Reimbursement Analyst

Employer
Altru Health System
Location
Grand Forks, ND
Salary
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Job Details

Job Summary
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
  • 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.
  • Assists with preparation of reports and report analysis for reimbursement and utilization issues. Completes financial analysis regarding reimbursement and compliance issues or opportunities.
  • 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.
  • Performs other duties as assigned or needed to meet the needs of the department/organization.
  • Demonstrates understanding and follows infection control policies and procedures according to standard operating procedure.
  • Maintains requirements for age specific competencies for the position and demonstrates the knowledge or principles of growth and developments and the skills necessary to provide patient/customer care/services.
  • Demonstrates knowledge and understanding of and compliance with:
    • All pertinent safety, health and environmental policies, procedures and guidelines.
    • Working safely, without causing harm or risk to self, others or property.
    • The work environment safety procedures and prompt reporting of unsafe practices, procedures, accidents, injuries or other safety violations to the Leader.
    • The use of all safety equipment and personal protective equipment.
Driving Requirements
  • Professional Drivers: Persons who drive as their main responsibility OR transport passengers or hazardous materials.
  • Frequent Drivers: Persons whose main responsibility is not driving, but drive daily or almost daily.
  • Occasional Drivers: Persons who drive from once per month to as frequently as once per week.
  • Infrequent Drivers: Persons who are generally not expected to drive.
License, Certification & Registration
Must have associates degree + 5 years of experience to be considered.

Education & Experience
Degree/Diploma

Program of Study

Required/Preferred

Bachelor's

Business

Preferred

Or

Associate's

Business

Required

Or

Associate's

Related Field

Required

Experience

Required/Preferred

A minimum of 1 year of related experience

Required
Knowledge & Skills
Title

Required/Preferred

Demonstrates the ability to effectively communicate both verbally and in written format.

Required

Knowledge of IPPS/OPPS, MSDRG's APC's, etc., also ICD9, CPT, etc.

Required

Physical Demands Frequency 8 Hour Shift 10 Hour Shift 12 Hour Shift Rarely (1-4%) 1-19 min 1-24 min 1-29 min Occasionally (5-33%) 19 min-2.6 hrs 24 min-3.3 hrs 29 min-3.9 hrs Frequently (34-66%) 2.6-5.3 hrs 3.3-6.6 hrs 3.9-7.9 hrs Continuously (67-100%) 5.3-8 hrs 6.6-10 hrs 7.9-12 hrs

Activity

Frequency

Sit

Continuously (>67%)

Stand

Occasionally (5-33%)

Walk

Occasionally (5-33%)

Stoop/Bend

Occasionally (5-33%)

Reach

Frequently (34-66%)

Climb

Not Applicable

Crawl

Not Applicable

Squat/Crouch/Kneel

Occasionally (5-33%)

Twist

Occasionally (5-33%)

Handle/Finger/Feel

Continuously (>67%)

See

Continuously (>67%)

Hear

Continuously (>67%)
Weight Demands
Activity

Amount

Lift - Floor to Waist Level

Sedentary (
Carry

Sedentary (
Push/Pull

Sedentary (
Slide/Transfer

Not Applicable
Working Conditions
Condition

Frequency

Indoor

Continuously (>67%)

Outdoor

Not Applicable

Extreme Temperature

Not Applicable

Employee Health
Functional Assessment

Hazardous Drug Exposure

Fit Testing Required

Not Applicable

No

No

Company

Do what you love. Make a difference. Join our team of over 4,000 health professionals and support staff committed to caring for the region for more than 100 years.

At Altru Health System, we are serious about providing an exceptional patient experience and positively impacting the communities we serve. Our physician-led, community-owned, not-for-profit health system serves over 225,000 residents in northeast North Dakota and northwest Minnesota. We are a proud member of the Mayo Clinic Care Network.

If reasonable accommodation is needed to apply or interview for a position, please contact careers@altru.org or 701.780.5123.

Company info
Website
Telephone
701-780-5123
Location
Grand Forks
North Dakota
US

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