Payor Reimbursement Analyst

Start the day excited to make a difference…end the day knowing you did.  Come join our team.

Job Summary:

This position is responsible for providing analytical expertise related to all third party reimbursements. Primary duties include managing the process and providing financial analysis and payor contract modeling for commercial managed care payors as well as governmentpayors, including Medicare, Medicaid, and Tricare. Duties will include contract rate structure system loading, extensive analytical reporting and modeling of managed care contracts, including but not limited to determining the financial impact of various payor proposals and rate structures in whole and by service line, an understanding of Medicare/Medicaid reimbursement logic and the ability to convert this logic into the current financial systems, and working with the appropriate internal parties to ensure payment variances are kept to a minimum and reimbursement is maximized. This role will require extensive knowledge of internal financial systems and the ability to manipulate a wide range of data to provide requested outcomes. Role also requires understanding the financial impact of managed care contracting and supporting all financial databases in order to produce accurate reporting regarding reimbursement outcomes. This position must demonstrate a commitment of quality service to our patients, the community and our internal and external customers.

Essential Functions & Responsibilities:

• Models and imports contractual terms, conditions, and logic using the Payor Relations & Contracting network modeling tool.
• Analyzes and produces payor financial impact for all contract proposals. Provides recommendations on specific rate methodology and logic necessary for desired negotiation outcomes during all managed care payor negotiations.
• Performs negotiation retrospective impact analyses to ensure the actual financial results meet the negotiation financial target.
• Utilizes contract modeling and cost accounting software to analyze/model the impact of contract rate proposals between MWHC and appropriate managed care payors and provides input on services where financial improvement is needed.
• Analyzes the reimbursement impact of changes in government regulations, regulatory code changes/deletions/revisions, key managed care contracts, and third party billing policies or requirements and reports financial impact to Manager.
• Monitors hospital patient discharges and denials by payer type and diagnosis for revenue opportunities.
• Reviews and analyzes Medicare Transfers for Post-Acute discharge destination to validate that corrected discharge code was billed. Provides feedback to MWHC departments as needed to improve and ensure accurate discharge destination assignment.
• Educates, prepares, and supports MWHC leadership on reimbursement issues and the potential impact on revenue and cash flow.
• Participates on committees and workgroups, as appropriate, to provide guidance on reimbursement issues.
• Attends internal/external events to keep abreast of current reimbursement methodologies and approaches for managed care, Medicare/Medicaid and apply knowledge to financial analyses as necessary.
• Performs other duties as assigned.

Qualifications:

• Bachelor’s Degree in Business, Finance, Healthcare Management or Information Technology/Computer Science required.
• Two (2) years financial analysis work experience required.
• Financial analysis/impact experience in the healthcare field related to managed care reimbursement and government payors preferred.
• Strong computer skills relevant to the position required. Significant experience using Excel, Access Database, and Word required. Knowledge of Lawson, Siemen's systems, DSS and managed care contract modeling software preferred.
• Strong knowledge of the hospital revenue cycle and/or finance including billing, case management, registration, collections and managed care contracting preferred.
• Strong understanding of the meaning of coding as it relates to reimbursement. (e.g., CPT, DRG, ICD-9, Revenue Codes, HCPCS, OPPS, APC) preferred.
• Certified Healthcare Financial Professional (CHFP) preferred.
• Experience in managed care contract modeling preferred.
• Strong analytical skills with ability to work independently and within a team required.
• Ability to manage and prioritize multiple projects required.
• Strong verbal, written and presentation skills required.

As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.