Senior Reimbursement Analyst (Remote)
About The Position
Purpose Work Remote Position Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing of department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications. Analyzes tentative and final settlements. Coordinates, researches and analyzes prior year reopening and appeals. Prepares financial month end close reporting for Net Revenue. Responsibilities include, but are not limited to, accessing databases, and utilizing reporting tools to extract data, generate reports, perform data analysis, and draft system/process improvement recommendations. Prepares analyses and interprets highly complex reimbursement issues. Prepares complex financial models and analyses to assure proper reimbursement. Participates in third-party payer preparing impact analysis and recommendations . Reviews and analyzes member organization third party reserves and net revenue/contractual calculations. Prepares project analysis regarding operational issues, new programs, service lines, expansions, etc. Note: “patients” refers to patients, clients, residents, participants, customers, members Essential Functions Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports. Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge. Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. Functional Role (not inclusive of titles or advancement career progression) Conducts prospective analysis of the potential financial impact on the member organizations of major changes in Medicare and Medicaid policies. Assists in related advocacy efforts regarding such regulatory changes. Prepares Medicare and Blue Cross home office cost reports for the Trinity Health Corporate Office and Trinity Information Systems. Participates in the Medicare and Blue Cross audits of Trinity Health Corporate Office, Trinity Information Systems, and the various insurance programs. Participates in third party payer contract negotiations, preparing impact analysis and recommendations. Provides analytical reimbursement support, consulting, and education to the corporate office and member organizations.
Requirements
- Bachelor’s degree in business administration, accounting, finance, informatics or related field, or an equivalent combination of education and related experience
- 5 plus years of experience in progressively responsible operational or consulting for revenue management (e.g., reimbursement, cost reporting, forecasting, decisions support, health information management)
Responsibilities
- data capture, analysis & reporting of data information
- auditing of department information
- producing reports
- suggesting improvements to processes
- analyzes tentative and final settlements
- Coordinates, researches and analyzes prior year reopening and appeals
- Prepares financial month end close reporting for Net Revenue
- accessing databases, and utilizing reporting tools to extract data, generate reports, perform data analysis, and draft system/process improvement recommendations
- Prepares analyses and interprets highly complex reimbursement issues
- Prepares complex financial models and analyses to assure proper reimbursement
- Participates in third-party payer preparing impact analysis and recommendations
- Reviews and analyzes member organization third party reserves and net revenue/contractual calculations
- Prepares project analysis regarding operational issues, new programs, service lines, expansions, etc
- Conducts prospective analysis of the potential financial impact on the member organizations of major changes in Medicare and Medicaid policies
- Assists in related advocacy efforts regarding such regulatory changes
- Prepares Medicare and Blue Cross home office cost reports for the Trinity Health Corporate Office and Trinity Information Systems
- Participates in the Medicare and Blue Cross audits of Trinity Health Corporate Office, Trinity Information Systems, and the various insurance programs
- Provides analytical reimbursement support, consulting, and education to the corporate office and member organizations
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
501-1,000 employees
