Note: The job is a remote job and is open to candidates in USA. Sanford Health Plan is hiring a Reimbursement Analyst to provide analytical and reimbursement support across Sanford Enterprise operating segments. The role supports reimbursement strategy, payment methodology analysis, contract and pricing work, reporting, and operational and accounting teams.
Responsibilities
- Assists in analyzing and implementing new payment methodologies in order to establish optimal reimbursement and payment levels
- Participates in the implementations and monitoring of reimbursement functions, which includes Medicare, Medicaid or other third party cost reports, related audits, appeals, disproportionate share hospital (DSH) programs, drug discount programs (340B) and CPT/HCPCS code changes
- Prepares the impact analysis of payor proposed and final Medicare and Medicaid regulation changes
- Assists with the impact analysis of payor contract changes during negotiations and finalizations of contracts
- Prepares third party payor contracts in Experian and Contract Maintenance (i.e. hospital and clinic payment integrity tools)
- Researches third party payor issues
- Supports the annual pricing and fee schedule updates, including impacts on physician compensation
- Assists in the annual budgeting and audit processes such as monthly discounts, year-end discounts and third party reserves
- Provides on-going support of operations and CDM team in maintaining chargemasters, particularly as it relates to setting up new codes and establishing prices
- Assists in on-going pricing initiatives across the enterprise
- Produces reports, analyzes and integrates data alongside completing other projects accurately and efficiently
- Possesses strong attention to detail
- Promotes integrity and confidentiality of data when sharing with others
- Prepares data in a useful and understandable format
- Accepts and responds to questions and challenges regarding information provided
- Supports relationships with finance and accounting staff across the enterprise
- Serves as a resource for individuals while providing reimbursement and accounting support
- Reviews and assists in revising policies and procedures when directed
Skills
- Bachelor degree required in business administration, finance, healthcare management, information technology (IT) or related field
- Minimum two years of related work experience
- Demonstrated knowledge and experience in health care reimbursement related to claim editing, groupers, provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS) 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
- Preferably in hospital, clinic or insurance finance and/or managed care reimbursement
Benefits
- This position offers the flexibility of working remotely, enabling team members to collaborate effectively while maintaining a healthy work-life balance.
Company Overview
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