Reimbursement Analyst

Job Summary:

The Reimbursement Analyst will be responsible for preparing the monthly contractual allowances for all payors and preparing analyses for month-end close meetings.

The Reimbursement Analyst will assist in the annual contractual budget and forecasting processes. The analyst should have a proficient knowledge of federal and state rules and regulations.

Essential Responsibilities:

• Prepares the calculation of Accounts Receivable and reserves for all payors including the timely submission of the monthly journal entry.
• Prepares all contractual allowance percentages from zero balance account data.
• Prepares trend reports and analyses of charges, payments, and contractual allowance and explains significant variances.
• Assists in the annual contractual budget and forecasting process.
• Assists with the annual financial audit.
• Reviews payor contract rates and ensures timely update of contract provisions in the EPIC contract management system.
• Performs reviews of over and under payments based on expected reimbursement to amounts allowed by payors.
• Researches root-cause for issues arising from the monthly AR valuation.
• Performs interim-month reviews of patient accounts and evaluates impact on month-end AR valuation.
• Works with Patient Financial Services to determine the impact of billing operations to AR valuation.
• Works with revenue cycle staff to acquire data regarding payment, denials, and other related data as it relates to AR valuation.
• Prepares logs and data needed for the preparation of Medicare and Medicaid cost reports and interim reviews.
• Prepares Medicaid logs that match the Medicaid cost report in the required format in a timely manner.
• Prepares various financial analyses as requested by management.
• Maintains current working knowledge of Medicare, Medicaid, and other regulations.
• Prepares and analyzes financial data for opportunities.
• Attends staff meetings and completes annual competency testing.

Basic Qualifications:

Experience:

• Minimum five (5) years of experience related to charge description master (CDM) or Revenue Cycle.

Education:

• Bachelor's degree OR four (4) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration:

• N/A

Additional Requirements:

• Excellent written and communication skills.
• Ability to write, present, and explain recommended materials in a clear, concise, and organized format.
• Proficient in Word and Excel applications.
• Proven analytical skills.
• Experience in the use of CPT, HCPCS, and Revenue Codes.
• Knowledge of medical terminology, coding rules, state and federal compliance rules and regulations.
• Working knowledge of Epic.

Preferred Qualifications:

• Epic Certification.
• Working knowledge of Access and other necessary computer applications.
• Ability to function in multiple capacities.
• Strong analytical, problem-solving, listening, and resolution skills.
• Ability to compose reports and recommendations.
• Strong interpersonal and communication skills.
• Detail-oriented, problem-solving, listening, and resolution skills.
• Strong time management skills and ability to meet deadlines.
• Demonstrated work attendance.
• Flexibility to complete immediate projects as needed.