Reimbursement Analyst

2 months ago
7.5 Hour
Clerical / Admin Support
Shift Details
8am - 4pm w-variable hours possible as needed
CPH Main Campus
Education: Required Level
Bachelor's Degree
Education: Preferred Level
Master's Degree
Education: Required Field
Bachelor’s degree in accounting, business administration or related field.
Education: Preferred Field
Master’s degree in accounting, business administration or related field.

Job Summary

Under general supervision of the Controller, is responsible for business process review which ensures accurate payments and operational efficiency, creating and maintaining fee schedules, maintaining current reimbursement methodologies, researching and/or developing new reimbursement methodologies and documentation and testing of system configuration changes; is responsible for maintaining files for all payer contracts for all organizations, acting as a resource during payer contract negotiations including providing financial impact analysis of proposed agreements; and assist in the compilation and completion of the annual cost reports and any audits or requests for information pertaining to the cost reports.

Core Responsibilities

Core Job Responsibilities:


Research and Data Analysis: Responsible for the development and maintenance of pricing source libraries, files and fee schedules on a regular basis, using Medicare, Medicaid, NDC, and other pricing sources, in conjunction with actively monitoring both local and national industry regulations relating to fee schedules and adopted payment methodologies. Provide ongoing maintenance to our proration system and dictionaries to ensure accurate expected payments from payers and monitor against actual payments received. Routinely monitor payments and identify opportunities to improve accurate provider payment by performing root cause analysis on specific examples and routine review of payments on our high-dollar services. Prepare ongoing reports through own development or at the request of the Controller or CFO.  


Information Administration: Manage payer contracts, including hard copy and electronic files and data, ensuring appropriate confidentiality of information access and retrieval; utilizes office information systems for on-demand information retrieval, preparation of communications and reports. Develop filing system that manages active contracts and ensure that appropriate staff has ongoing access and knowledge of the most current contracts. Maintain a matrix of current payers by organization for routine distribution.Provides data support as requested including preparation of financial analysis to project anticipated performance under proposed agreements.


Accounting: Reconcile patient accounts receivable routinely and prepare ongoing reserve calculations on open accounts receivable based on paid-to-zero analysis by payer. Performs monthly reviews and problem solves to ensure the accuracy of accounts receivable by payer. Review budget to actual reports for contractual allowances routinely and conduct analysis on variances.  Support the annual financial audit by preparing schedules and analysis as requested.  Assist in the budget process calculation of contractual allowances by payer and net revenue.  Assist with the preparation of the annual Medicare and Medicaid cost reports and ongoing requests for information including audits.


Required Experience:


Required: Two years of recent experience in financial analysis.


Preferred: Experience in a healthcare.




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