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Adventist Health · 2 weeks ago

Sr. Reimbursement Analyst

ONE Adventist Health Way, Roseville, CA, 95661, US

Full-time

Onsite

Senior Level

$77K/yr - $116K/yr

5+ years exp

Adventist Health is a healthcare organization based in Roseville, California, and they are seeking a Senior Reimbursement Analyst. The role involves developing and maintaining systems for valuing Patient Accounts Receivable and Third-party settlements, ensuring accurate filing of government cost reports, and managing adjustments by government auditors.

Elder CareHealth CareHospitalMedicalNon ProfitWellness

Responsibilities

Reviews, analyzes and interprets executed insurance contracts, government regulations and other noncontracted business reimbursement methods. Sets up and maintains a Patient Account Receivable valuation system using historical payment averages with the use of logic and judgment to effectively represent most accurate result

Reviews, analyzes and interprets government regulations, applicable contract terms and cost accounting principles to set up and maintain monthly Settlement estimates which accurately calculate expected payments and contractual adjustments from all payers

Analyzes revenue and contractual adjustment variances against both budget and historical trend, by both payer and business segment to inform the markets about their operational performance results on a monthly basis. Present variances to management in standardized categorizes such as volume, payer mix, service mix, acuity mix, prior period adjustments and yield

Works with local markets, system shared services units and, as appropriate, with external consultants to collect and evaluate all information necessary for the accurate and complete preparation of both interim cost reports, and the filing of annual governmental cost reports

Works with all appropriate internal parties to defend filed cost reports to government auditors. Tracks and manages the settlements of Prior Year cost reports and any appropriate appeals of adjustments included by the auditors in their final Notice of Program Reimbursement reports

Performs other job-related duties as assigned

Qualification

Patient Accounts ReceivableInsurance Contract AnalysisGovernment Regulations InterpretationCost Accounting PrinciplesData AnalysisCommunication SkillsTeam Collaboration