Lead Reimbursement Analyst
Sanford Health
full-time
Posted on:
Location Type: Hybrid
Location: Fargo • North Dakota, South Dakota • 🇺🇸 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 in order 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.
- Directs the implementation 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/HCPS code changes.
- Leads the review and impact analysis of payor proposed and final Medicare and Medicaid regulation changes.
- Reviews and provides expertise in the impact analysis of payor contract changes during negotiations and finalizations of contracts.
- Consults and reviews third party payor contracts in Experian and Contract Maintenance (i.e. hospital and clinic payment integrity tools).
Requirements
- Bachelor's degree in Accounting, Business, or healthcare related field with strong financial focus.
- Minimum of seven years experience related to healthcare reimbursement with Medicare and other third party payers.
- Demonstrated understanding and proficiency related to health care reimbursement including claim editing, groupers, provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS) industry standard coding and payment rules.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
reimbursement analysispayment methodologiesclaim editinggroupersprovider reimbursementMS/APR DRGAPCEAPGCPTHCPCS
Soft skills
leadershipcoachingstrategic planningcommunicationpolicy creation