Reimbursement Analyst
About The Position
The Reimbursement Analyst provides analytical and reimbursement-related support to operating segments across the Sanford Enterprise. The role contributes to strategic Provider Network Economics initiatives that influence reimbursement strategy, provider partnerships, operational performance, and financial results. It involves cross-functional collaboration and exposure to senior leadership, with a focus on developing and supporting payment models that promote high-quality, affordable healthcare. This position may be performed remotely. The analyst assists with payment methodology analysis and implementation, reimbursement monitoring, regulatory and contract impact analyses, third-party payor research, annual pricing and fee schedule updates, budgeting and audit activities, chargemaster maintenance, and enterprise pricing initiatives. The role also prepares reports and data for use by others, supports finance and accounting relationships, and provides reimbursement and accounting assistance.
Requirements
- Bachelor's degree in business administration, finance, healthcare management, information technology, or a related field.
- Minimum 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 (MS/APR DRG, APC, EAPG, CPT/HCPCS), 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 help implement 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 analysis of 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, including setting up new codes and establishing prices.
- Assist with ongoing pricing initiatives across the enterprise.
- Produce reports, analyze and integrate data, and complete other projects accurately and efficiently.
- Promote the integrity and confidentiality of data when sharing it with others.
- Prepare data in a useful and understandable format and respond to questions and challenges regarding information provided.
- 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.
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What This Job Offers
Job Type
Full-time
