Mile Bluff Medical Center · 18 hours ago
Contract Reimbursement Analyst
Mauston,WI,US
Full-time
Onsite
Entry Level
1+ years expMile Bluff Medical Center is seeking a Contract Reimbursement Analyst to manage and analyze payer reimbursement processes. The role involves interpreting complex reimbursement methodologies, collaborating with various departments to support contract negotiations, and ensuring accurate payment according to contract terms.
Health CareHospitalMedical
Responsibilities
Review and interpret managed care contracts (commercial, Medicare Advantage, Medicaid MCOs). Translate contract terms into payment methodologies, identify carve-outs, stop-loss provisions, outlier terms, and reimbursement exceptions. Prepare and maintain contract summaries and reimbursement matrices for internal use
Build models to calculate expected reimbursement based on contract terms, analyze financial impact of new or renegotiated payer contracts, support contract negotiations with reimbursement projections and scenario modeling, assist evaluations on how coding, case mix, or volume changes affect reimbursement
Compare expected vs. actual payments at the claim level, identify underpayments, overpayments, and systemic payer issues and research root causes (incorrect DRG, fee schedule errors, bundling logic, modifier reductions). Quantify revenue impact and support recovery/escalation efforts
Develop recurring and ad hoc reports on payer reimbursement performance, net revenue by payer/product line, variance trends and recovery results, track contract compliance and identify unfavorable payment patterns, and present findings to CFO
Work closely with revenue cycle and billing department, coding and clinical documentation teams, quality and UR, finance and decision support and provide any necessary education on payer reimbursement rules and contract requirements
Assist with payer disputes and escalated payment issues
Assist with building and maintaining contract logic in contract management system, perform ongoing validation of reimbursement accuracy, test payment outcomes after fee schedule changes or contract renewals
Monitor Medicare and Medicaid payment updates that affect hospital reimbursement, track payer policy changes that may affect contract payments, and update internal reimbursement assumptions and models accordingly
Ensure contract terms are applied accurately and consistently, identify potential compliance risks related to billing and reimbursement, and support audit requests and documentation of reimbursement methodologies
Maintain and update the Chargemaster (Charge Description Master) File in the Meditech Expanse system
Ensure CDM entries align with CPT/HCPCS coding guidelines, Medicare OPPS and NCCI edits, CMS billing rules and status indicators, and supports compliance with payer billing requirements
Assist with CDM pricing reviews and annual price updates, work with CFO to evaluate pricing impact on reimbursement and cost reports
Perform other duties as requested
Qualification
Required
High school diploma or equivalent required
Exceptional accuracy and attention to detail required
Intermediate proficiency with computers is required
Ability to understand and calculate multiple reimbursement models to compare and contrast during contract negotiations
Knowledge of contract language and negotiation
Knowledge of the insurance industry
Strong quantitative and analytical competency
Self-starter with excellent interpersonal communication and problem-solving skills
Preferred
1+ years of related work experience preferred
Company
Mile Bluff Medical Center
Mile Bluff Medical Center offers rehabilitation, surgeries, dialysis, orthopedics, respiratory, emergency and nursing home care services.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Dara Bartels
Chief Executive Officer
SCOTT KNIPRATH
Chief Operating Officer & Vice President
Recent News
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