Vice President – Policy – Access and Coverage
PMA Companies
Lead Reimbursement Analyst
Sanford Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $31 - $50 per hour
Job Level
Senior
About the role
- Strategically leads the reimbursement team in analyzing and implementing new payment methodologies to establish optimal reimbursement and payment levels.
- Creates policies and procedures for reimbursement functions including estimating, modeling and reporting provider reimbursement/payment levels.
- Coaches others in the organization regarding reimbursement functions and third party payor issues.
- Directs implementation and monitoring of reimbursement functions including Medicare, Medicaid, cost reports, audits, appeals, DSH programs, 340B and CPT/HCPCS code changes.
- Leads review and impact analysis of payor proposed and final Medicare and Medicaid regulation changes.
- Reviews and provides expertise on payor contract changes during negotiations and finalizations; consults on third party payor contracts in Experian and Contract Maintenance.
- Directs reports for annual pricing and fee schedule updates, including impacts on physician compensation.
- Consults in annual budgeting and audit processes (monthly discounts, year-end discounts, third party reserves).
- Supports operations and CDM team in maintaining charge masters and setting up new codes and prices; assists with enterprise pricing initiatives.
- Produces reports, analyzes and integrates data; develops, summarizes, presents and explains data.
- Promotes integrity and confidentiality of data; develops and updates policies and procedures when directed.
- Develops and maintains relationships with finance and accounting staff across the enterprise and provides coaching and reimbursement support.
Requirements
- Bachelor's degree in Accounting, Business, or healthcare related field with strong financial focus.
- Minimum of seven years experience related to reimbursement with Medicare and other third party payers.
