Lead Reimbursement Analyst at Sanford Health

Houghton, Michigan, United States -

Full Time

Start Date

Immediate

Expiry Date

20 Feb, 26

Salary

49.5

Posted On

22 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Reimbursement Analysis, Payment Methodologies, Policy Development, Coaching, Data Analysis, Financial Reporting, Healthcare Regulations, Contract Negotiation, Budgeting, Auditing, Attention to Detail, Data Integrity, Relationship Management, Healthcare Coding, Provider Reimbursement, Cost Reporting

Industry

Hospitals and Health Care

Description

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Salary Range: $31.00 - $49.50 Union Position: No Department Details Summary The Lead Reimbursement Analyst provides critical analytical and reimbursement related direction, guidance and support to operating segments across the Sanford Health enterprise. Job Description 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). Acts as a resource while coaches others regarding third party payor issues. Directs reports for the annual pricing and fee schedule updates including impacts on physician compensation. Consults in the annual budgeting and audit process such as monthly discounts, year-end discounts and third party reserves. Contributes and monitors on-going support of operations and CDM team in maintaining and charging masters particularly as it relates to setting up new codes and establishing prices. Assists in on-going pricing initiatives across the enterprise. Reviews and 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. Develops, summarizes, presents and explains data in useful and understandable formats. Accepts and responds to questions and challenges regarding information provided. Develops and maintains relationships with finance and accounting staff across the enterprise. Coaches individuals and provides reimbursement and accounting support. Develops, reviews and updates policies and procedures when directed. Qualifications 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. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org. Sanford Health, one of the largest health systems in the United States, is dedicated to the integrated delivery of health care, genomic medicine, senior care and services, global clinics, research and affordable insurance. Headquartered in Sioux Falls, South Dakota, the organization includes 44 hospitals, 1,400 physicians and more than 200 Good Samaritan Society senior care locations in 26 states and nine countries.

Responsibilities

The Lead Reimbursement Analyst strategically leads the reimbursement team in analyzing and implementing new payment methodologies to establish optimal reimbursement levels. They also direct the implementation and monitoring of reimbursement functions, including Medicare and Medicaid cost reports and related audits.