Reimbursement Analyst, Health Plan - ND, SD, MN, WI
Sanford Health
Summary
The Reimbursement Analyst provides analytical and reimbursement related support to operating segments across the Sanford Enterprise, working with all operating segments.
Job description
Summary
The Reimbursement Analyst provides analytical and reimbursement related support to operating segments across the Sanford Enterprise, working with all operating segments.
Job Description
Assists in analyzing and implementing new payment methodologies in order to establish optimal reimbursement and payment levels. Participates in the implementations and monitoring of reimbursement functions, which includes Medicare, Medicaid or other third party cost reports, related audits, appeals, disproportionate share hospital (DSH) programs, drug discount programs (340B) and CPT/HCPCS code changes.
Prepares the impact analysis of payor proposed and final Medicare and Medicaid regulation changes. Assists with the impact analysis of payor contract changes during negotiations and finalizations of contracts. Prepares third party payor contracts in Experian and Contract Maintenance (i.e. hospital and clinic payment integrity tools). Researches third party payor issues. Supports the annual pricing and fee schedule updates, including impacts on physician compensation. Assists in the annual budgeting and audit processes such as monthly discounts, year-end discounts and third party reserves.
Provides on-going support of operations and CDM team in maintaining chargemasters, particularly as it relates to setting up new codes and establishing prices. Assists in on-going pricing initiatives across the enterprise. Produces reports, analyzes and integrates data alongside completing other projects accurately and efficiently. Possesses strong attention to detail. Promotes integrity and confidentiality of data when sharing with others. Prepares data in a useful and understandable format. Accepts and responds to questions and challenges regarding information provided. Supports relationships with finance and accounting staff across the enterprise. Serves as a resource for individuals while providing reimbursement and accounting support. Reviews and assists in revising policies and procedures when directed.
Requirements
- Bachelor degree required in business administration, finance, healthcare management, information technology (IT) or related field.
- Minimum two years of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement.
- Demonstrated knowledge and experience in health care reimbursement related to claim editing, groupers, provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS) industry standard coding and payment rules.
- Minimum one year of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement.
Benefits
- Remote work flexibility
Company overview
Sanford Health is one of the largest integrated healthcare delivery systems in the United States, operating as a nonprofit organization headquartered in Sioux Falls, South Dakota. Founded in 1894, the organization has grown into a comprehensive health system with 44 medical centers, 482 clinics, and more than 200 senior living facilities across 26 states and nine countries. Sanford Health provides a full spectrum of healthcare services including acute care hospitals, specialty clinics, senior care through the Good Samaritan Society, genomic medicine, global clinics, and the Sanford Health Plan insurance program. The system employs over 48,000 healthcare professionals including 1,400 physicians and delivers care through five Centers of Excellence: Cancer, Children's, Heart, Orthopedics/Sports Medicine, and Women's Health. Annually, Sanford Health handles approximately 5.3 million outpatient visits, 84,000 admissions, and 136,000 surgeries. The organization is also actively involved in medical research and education through partnerships with academic institutions, positioning itself as a regional healthcare leader in the Midwest with expanding international presence.