Reimbursement Analyst

🔥 12 hours ago

🌾 North Dakota, Minnesota, +2 more states – Remote

🌾 North Dakota – Remote ❄️ Minnesota – Remote 🗿 South Dakota – Remote 🧀 Wisconsin – Remote

💵 $24 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• Analyze and implement new payment methodologies to establish optimal reimbursement and payment levels • Participate in implementation and monitoring of reimbursement functions, including Medicare, Medicaid, third-party cost reports, audits, appeals, DSH programs, 340B drug discount programs, and CPT/HCPCS code changes • Prepare impact analyses of proposed and final Medicare and Medicaid regulation changes • Analyze payor contract changes during negotiations and finalizations • Prepare third-party payor contracts in Experian and Contract Maintenance • Research third-party payor issues • Support annual pricing and fee schedule updates, including physician compensation impacts • Assist with annual budgeting and audit processes • Support operations and CDM teams in maintaining chargemasters and setting up new codes and prices • Produce, analyze, and integrate data for projects and reports • Support finance and accounting relationships across the enterprise • Provide reimbursement and accounting support and serve as a resource • Review and assist in revising policies and procedures

🎯 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 • Minimum one year 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) • Knowledge of industry standard coding and payment rules • Strong attention to detail • Ability to promote integrity and confidentiality of data • Ability to prepare data in a useful and understandable format

🏖️ Benefits

• Flexible remote work • Work-life balance • Exposure to senior leadership • Extensive cross-functional collaboration • Growth and continuous learning opportunities