Ambulatory Reimbursement Analyst
About The Position
The Ambulatory Reimbursement Analyst prepares and analyzes monthly contractual adjustment journal entries for Adventist Health’s physician clinics. The role assists with the annual net revenue budget and provides explanations for monthly variances to budget and budget-to-trend comparisons. The analyst presents mathematical modeling and data analysis to management and other users, analyzing net revenue variances by clinic and carrier type for budget analysis and presentations to finance officers, finance staff, and physician enterprise executives. The role uses data sources such as SQL Server pivot tables and Power BI dashboards to examine reimbursement and charging patterns across specialties, applying knowledge of clinic reimbursement methodologies and insurance payment requirements. The position also monitors billing-system issues and coordinates with coding, registration, and other staff to resolve issues affecting general ledger assignment. Additional duties include applying collection rates where historical information is unavailable, preparing chargemaster pricing based on Medicare and commercial fee schedules by CPT code, modeling net revenue forecasts for clinic model changes, and contributing to team problem-solving and improvement processes. Other job-related duties may be assigned.
Requirements
- Bachelor’s degree in accounting, finance, economics, business administration, or a related field.
- Advanced Excel knowledge, including pivot tables, LOOKUP, INDEX, MATCH, and GETPIVOT.
- Basic accounting knowledge, including creating journal entries from data and understanding debits and credits.
- Receive all required vaccinations as a condition of employment and annually thereafter where applicable; medical and religious exemptions may apply.
Nice To Haves
- Master’s degree in business administration.
- Three years of experience in healthcare reimbursement or revenue cycle.
Responsibilities
- Prepare and analyze monthly contractual adjustment journal entries for physician clinics.
- Assist with the annual net revenue budget and explain monthly variances to budget and budget-to-trend comparisons.
- Present mathematical modeling and data analysis to management and other end users.
- Analyze and explain net revenue variances by clinic and carrier type for monthly and annual budget analysis and presentations to finance staff and physician enterprise executives.
- Use SQL Server data, pivot tables, and Power BI dashboards to analyze reimbursement and charging patterns across practice specialties.
- Apply knowledge of clinic reimbursement methodologies and insurance requirements and payment methodologies to understand and explain net revenue variances.
- Monitor billing-system issues and work with coding, registration, and other staff to resolve issues affecting general ledger assignment.
- Apply collection rates for clinics and payer categories without available historical information.
- Provide chargemaster pricing for foundation clinics based on Medicare and commercial fee schedules by CPT code.
- Model net revenue forecasts for clinic model changes, such as conversion from an independent clinic to a hospital-based or rural health clinic.
- Work with a team to identify problems and participate in instituting improvement processes.
- Perform other job-related duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
