Reimbursement Analyst

About the Job - Remote Work in AL, FL, GA, IN, LA, MS, NV, NC, OK, SC, VA, WY

Location: NHRMC Business Center A

Department: Coding and Revenue Integrity

Full Time Equivalent: full-time

Work Type: 64 to 80 Hours Pay Period

Work Schedule: STD HRS - Standard-Exe or Office w flex

Exempt from Overtime: Exempt: Yes

What You'll Do

Summary:

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

Responsibilities:

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.

Position Requirements

Credentials:

Education:
Bachelor of Science

Other information:

1. Education: Bachelor’s Degree in Accounting, Finance, Economics, Health Care Administration or related field required.

2. Licensure/Certifications: None required. CPA or HFMA certification preferred.

Experience: Minimum of one year of experience in data analysis required. Excellent analytical skills and ability to manipulate large data sets from multiple systems using MS Office (including Excel and Access), or other database management tool. Ability to distill data to information and recommendations and present findings of all analyses in a logical, concise manner and format required. Excellent communication skills required. Basic accounting, financial or economical analytic skills required. Ability to manage, prioritize, and take ownership of a variety of projects and demonstrate progress, meet deadlines, and bring items to closure. Comply with and proactively support departmental and organizational vision, strategic imperatives, and policies and procedures. Develop a strong team player environment, prompt open effective communication, and constructively resolve internal and external conflicts. Familiarity with current common coding practices including CPT4, ICD10CM, and DRGs as well as current Medicare reimbursement methodologies. Knowledge of pricing, healthcare finance, managed care, provider incentives, and risk contracting preferred. Understanding of healthcare alternate payment models and risk contracts for populations, a plus. Health insurance experience, a plus. SQL experience a plus. 

Other Information

Consider a career at NHRMC and become part of this award winning team!