Sr. Reimbursement Analyst

Adventist Health • Roseville, CA

2d • $78,000 - $116,104

About The Position

The Sr. Reimbursement Analyst develops and maintains systems for valuing patient accounts receivable and third-party settlements, and explains net revenue variances against budget and historical trends. The role ensures complete data collection for accurate government cost reports, tracks and manages government auditor adjustments, and ensures appeals are filed for adjustments considered inappropriate.

The analyst reviews insurance contracts, government regulations, contract terms, and cost accounting principles to maintain receivable valuation and monthly settlement estimate systems. The position analyzes revenue and contractual adjustment variances by payer and business segment, communicates operational performance results to markets and management, and works with internal teams and external consultants as appropriate to prepare and defend cost reports.

Requirements

• Bachelor's degree or equivalent combination of education and related experience.
• All associates must receive required vaccinations as a condition of employment and annually thereafter, where applicable; medical and religious exemptions may apply.

Nice To Haves

• Five years of relevant experience.

Responsibilities

• Review, analyze, and interpret executed insurance contracts, government regulations, and noncontracted business reimbursement methods.
• Set up and maintain a patient accounts receivable valuation system using historical payment averages, logic, and judgment.
• Review government regulations, applicable contract terms, and cost accounting principles to maintain monthly settlement estimates of expected payments and contractual adjustments from all payers.
• Analyze revenue and contractual adjustment variances against budgets and historical trends by payer and business segment, and inform markets about monthly operational performance.
• Present variances to management in standardized categories, including volume, payer mix, service mix, acuity mix, prior-period adjustments, and yield.
• Work with local markets, system shared services units, and external consultants as appropriate to collect and evaluate information for interim and annual governmental cost reports.
• Work with internal parties to defend filed cost reports to government auditors.
• Track and manage prior-year cost report settlements and appeal appropriate auditor adjustments included in final Notice of Program Reimbursement reports.
• Perform other job-related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior