Reimbursement Analyst Entry-Level

Profile

What You Will Do:
General Summary
Under general supervision reports, analyzes, audits, and interprets financial, patient, and charge data to assist management in evaluating and executing hospital business plans to maximize revenue and maintain compliance with Health Services Cost Review Commission (HSCRC) and Center for Medicare and Medicaid Services (CMS) regulations. Provides support to other members of finance, clinical departments, and hospital staff. Analyzes, reports and assists with the interpretation of hospital specific volume data. Serves as corporate liaison to assigned services/hospitals and supports other team members. The employee will be assigned to a specialized functional area such as case mix, charge description master (CDM), policy and methodology, and/or rate setting.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Produces and distributes routine internal reports for monthly financial processes and revenue maximization initiatives to include, but not limited to, reimbursement strategies, case mix audits, clinical documentation reviews, CDM audits and quality-based reimbursement programs.
2. Produces and submits various reports and data submissions to external agencies. Ensures complete and accurate data capture in compliance with published regulations and deadlines for assigned hospitals.
3. Assists with the development and coordination of educational in-services to clinical departments, CBO, IS&T and other administrative staff related to CPT, CMS and HSCRC regulations as well as charging and billing issues.
4. Responsible for performing audits with a focus on accuracy, maintaining compliance with regulatory agencies, and assisting facilities with charge capture, billing, coding, clinical documentation and compliance issues.
5. Analyzes reports to determine areas of improvement or in need of further investigation; determines appropriate plan of action and works with department to rectify any charge capture problems. Exhibits a general knowledge of hospital specific charge capture processes to be able to effectively resolve issues.
6. Provides analytical and technical support regarding hospital volume changes and helps to resolve the issues identified.
7. Monitors and analyzes variances in financial, patient-level coded, and charge data to determine areas of improvement or in need of further investigation. Determines appropriate plan of action and works with departments and others to coordinate resolution of issues and identification of opportunities for improvement.
8. Fulfills ad-hoc data and reporting requests as needed.
9. Assists team members and management in developing, enhancing, and maintaining standard processes, reports, databases, and reference data to support accurate, consistent, efficient, and quality service to internal and external customers.
10. Participates in testing and data validation during new system implementations and upgrades to existing systems.
11. Attends and participates in in-service training and various educational programs for continuous professional development.
What You Need to Be Successful:
Education and Experience
1. Bachelor's degree is required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.
2. Prior financial and/or data work experience is preferred.
3. Healthcare-related finance background is preferred.
Knowledge, Skills and Abilities
1. Ability to process, assess, and summarize large amounts of financial and clinical data into useful information.
2. Knowledge and experience with spreadsheets, word processing, and other finance related software programs. Knowledge of databases (MS-Access), SAS, and/or Tableau preferred but not required.
3. Understanding of data flow and information systems of business operations.
4. Concern for quality and ability to identify errors and implement corrections.
5. Effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff.
6. Ability to work effectively in a matrix work environment and to manage multiple deadline-driven tasks and projects.
7. Minimal knowledge or demonstrated ability to learn and understand HSCRC/CMS regulations, CPT (Current Procedural Terminology), and ICD-10 coding.
8. Ability to operate a personal computer is required. Proficiency with the following applications is required: MS Excel, MS Word, and PowerPoint. MS Access, SAS, & Tableau is preferred.
9. Ability to handle confidential issues with integrity and discretion.
10. Ability to prioritize and manage work in a stressful environment.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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