Sr. Reimbursement Analyst

Adventist Health • Roseville, CA

23h • Onsite

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 and tracks adjustments made by government auditors, filing appeals when adjustments are considered inappropriate.

The analyst reviews insurance contracts, government regulations, reimbursement methods, contract terms, and cost accounting principles. They maintain patient accounts receivable valuation and monthly settlement estimates, analyze revenue and contractual adjustment variances by payer and business segment, and present results to management. The role also works with local markets, shared services teams, external consultants, and internal stakeholders to prepare and defend interim and annual governmental cost reports and manage prior-year settlements and appeals. Other job-related duties may be assigned.

The position is based at Adventist Health’s corporate headquarters in Roseville, California. Adventist Health requires associates to receive required vaccinations as a condition of employment and annually thereafter where applicable; medical and religious exemptions may apply. Adventist Health participates in E-Verify.

Requirements

• Bachelor’s degree or equivalent combination of education and related experience.
• Five years of relevant experience is preferred.

Responsibilities

• Review, analyze, and interpret executed insurance contracts, government regulations, and reimbursement methods for noncontracted business.
• 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 set up and maintain monthly settlement estimates that calculate expected payments and contractual adjustments from all payers.
• Analyze revenue and contractual adjustment variances against budget and historical trends by payer and business segment, informing markets about operational performance monthly.
• Present variances to management using 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 settlements of prior-year cost reports and appeal appropriate adjustments included in auditors’ final Notice of Program Reimbursement reports.
• Perform other job-related duties as assigned.

What This Job Offers

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