Reimbursement Analyst, Health Plan - ND, SD, MN, WI
About The Position
The Reimbursement Analyst provides analytical and reimbursement-related support to operating segments across the Sanford Enterprise. The role supports strategic Provider Network Economics initiatives that influence reimbursement strategy, provider partnerships, operational performance, and organizational financial results. It involves collaboration across the enterprise and exposure to senior leadership, with a focus on developing and supporting payment approaches that advance high-quality, affordable healthcare. The position is remote and works with finance, accounting, operations, and chargemaster teams. The analyst prepares and analyzes reimbursement data, supports payment methodology and pricing work, and contributes to budgeting, audits, contract activity, and operational initiatives. The role requires attention to detail, confidentiality, clear communication of data, and the ability to respond to questions about analyses and information provided.
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 such as MS/APR DRG, APC, EAPG, and CPT/HCPCS.
- Knowledge of industry-standard coding and payment rules.
- Strong attention to detail.
- Ability to protect the integrity and confidentiality of data and communicate information in a useful and understandable format.
Nice To Haves
- Experience in hospital, clinic, or insurance finance and/or managed care reimbursement.
Responsibilities
- Assist with analyzing and 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 payer contract changes during negotiations and contract finalization.
- Prepare third-party payer contracts in Experian and Contract Maintenance.
- Research third-party payer issues.
- Support annual pricing and fee schedule updates, including analysis of impacts on physician compensation.
- Assist with annual budgeting and audit processes, including monthly discounts, 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 enterprise-wide pricing initiatives.
- Produce reports, analyze and integrate data, and complete other projects accurately and efficiently.
- Prepare data in a useful and understandable format while maintaining its integrity and confidentiality.
- Support relationships with finance and accounting staff across the enterprise and serve as a resource for 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
Career Level
Mid Level
