Reimbursement Analyst
About The Position
The Reimbursement Analyst provides analytical and reimbursement-related support to operating segments across the Sanford Enterprise. This position contributes to strategic Provider Network Economics initiatives that influence reimbursement strategy, provider partnerships, operational performance, and financial results. The role involves cross-functional collaboration and exposure to senior leadership, with the opportunity to support innovative payment models. The position may be performed remotely. The analyst assists with payment methodology analysis and implementation, reimbursement functions, payor regulation and contract impact analyses, pricing and fee schedule updates, budgeting and audit processes, chargemaster maintenance, and enterprise pricing initiatives. The role also produces and analyzes reports, supports finance and accounting staff, provides reimbursement and accounting guidance, and helps review and revise policies and procedures.
Requirements
- Bachelor’s degree in business administration, finance, healthcare management, information technology, or a related field.
- At least two years of related work experience; hospital, clinic, or insurance finance and/or managed care reimbursement experience is preferred.
- Demonstrated knowledge and experience in healthcare reimbursement related to claim editing, groupers, provider reimbursement, and methodologies such as MS/APR DRG, APC, EAPG, and CPT/HCPCS, as well as industry-standard coding and payment rules.
- Strong attention to detail.
Nice To Haves
- Experience in hospital, clinic, or insurance finance and/or managed care reimbursement.
Responsibilities
- Analyze and assist with implementing payment methodologies to establish optimal reimbursement and payment levels.
- Participate in implementing and monitoring reimbursement functions, including Medicare, Medicaid, and other third-party cost reports, related audits and appeals, DSH programs, 340B drug discount programs, and CPT/HCPCS code changes.
- Prepare impact analyses of proposed and final Medicare and Medicaid regulation changes.
- Assist with impact analyses of payor contract changes during negotiations and contract finalization.
- Prepare third-party payor contracts in Experian and Contract Maintenance tools.
- Research third-party payor issues.
- Support annual pricing and fee schedule updates, including impacts on physician compensation.
- Assist with annual budgeting and audit processes, including monthly and year-end discounts and third-party reserves.
- Provide ongoing support to operations and the CDM team in maintaining chargemasters, particularly for new codes and pricing.
- Assist with ongoing pricing initiatives across the enterprise.
- Produce reports, analyze and integrate data, and complete other projects accurately and efficiently.
- Prepare data in a useful and understandable format and respond to questions and challenges about information provided.
- Promote integrity and confidentiality when sharing data.
- Support relationships with finance and accounting staff across the enterprise.
- Serve as a resource by providing reimbursement and accounting support.
- Review and assist in revising policies and procedures when directed.
Benefits
- Remote work flexibility.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
