Works under the supervision of the Department leader. The Reimbursement Analyst develops, evaluates and implements pricing strategies and tactics. This analyst is responsible for pricing strategy decisions for the facility charge master and financial analysis for various and new emerging billable services and, payment arrangements including risk models, episodic contracts and other strategic projects. Acts as a customer and team oriented resource to accomplish departmental goals in a timely, accurate, efficient and positive manner
1. This position sets, reviews, and revises pricing and mark up tables for all items in the facility CDM.
2. Researches and develop opportunities for net revenue enhancement related to pricing.
3. Analyzes legislation and regulations impacting hospital revenues.
4. Responsible for ensuring compliance with price transparency regulations and requirements including shoppable services and machine- readable file.
5. Conducting thorough analysis of internal and external factors surrounding payor negotiations and renewals as well as ongoing proposal development and evaluation
6. Utilizing internal data systems and external data to drive analyses. Data sets will include claims and clinical sources. Reconciling and verifying data to ensure data integrity and reasonableness.
7. Building one-off financial projections, decision support models and financial reporting for evolving new products, performance programs, risk models and other initiatives
8. Develops and evaluates annual chargemaster price changes and provides appropriate rate increase notices to payers.
9. Assessing competitive pricing utilizing varying data sources
10. Providing pricing support for various multi-disciplinary projects and service lines in support of pricing strategy, strategic imperatives and revenue cycle activities
11. Predicting downstream impact of changing utilization, code and CDM changes.
12. Acts as a resource to departments on charge reconciliation, revenue and usage, and accurate pricing, including creation and maintenance or pricing and charging policies and procedures.
13. Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
14. Performs other duties as assigned.