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Become A Reimbursement Analyst

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Working As A Reimbursement Analyst

  • Getting Information
  • Communicating with Supervisors, Peers, or Subordinates
  • Establishing and Maintaining Interpersonal Relationships
  • Analyzing Data or Information
  • Organizing, Planning, and Prioritizing Work
  • Deal with People

  • Mostly Sitting

  • $99,130

    Average Salary

What Does A Reimbursement Analyst Do At Highmark Health

* Assists in preparation, evaluation, and maintenance of processes in support of regulatory and third party updates including quarterly work papers, annual audits, cost accounting, and third party cost reporting.
* Stays abreast of issues impacting the healthcare industry, especially those that have a financial impact to WPAHS (including the ability to read and evaluate government regulations) and communicates those issues to team and management.
* Records, classifies, and summarizes financial transactions and events in accordance with generally accepted accounting principles.
* Interprets financial transactions and events for users who make economic or business decisions.
* Maintains processes and performs calculations to support the monthly close process and the generation of the monthly financial statements.
* Provides expertise and education related to budgeting, revenue recognition, reimbursement, system, and process changes.
* Performs other duties as assigned or required

What Does A Reimbursement Analyst Do At Horizon Blue Cross Blue Shield of Nj

* Under supervision, performs and assists with quantitative and qualitative analysis of contract proposals to detect claims problems and recommend viable solutions, interim alternatives and documentation of processing irregularities.
* Assist in analyzing, evaluating, revising and/or developing system specification and modification request to ensure system functions are capable of handling business requirements.
* Monitor assigned tasks to ensure meeting of implementation dates, quality, operational effectiveness and adherence to corporate policy and standards.
* Coordinates the processing of special provider claims through appropriate channels.
* Research, coordinates and oversee development and implementation of special projects, studies and reports to satisfy the information demands of Management.
* Organizes meetings and conducts workshops with the hospital/ancillary provider patient account personnel to enhance claims processing knowledge.
* Acts as a resource to departmental personnel.
* Other projects as assigned by manager

What Does A Reimbursement Analyst Do At NYU Medical Center

* Perform audits to identify and recover underpayments caused by contract misinterpretation and invalid denials in order to maximize reimbursement, efficiently lower A/R, and expedite the revenue cycle process.
* Collect and analyze data to determine denial and underpayment trends across the Faculty Group Practice for review and distribution to leadership.
* Execute data mining and in-depth analysis to support managed care contracting initiatives
* Maintain data integrity when manipulating data files for purposes of analysis to ensure data does not become corrupted through conscientious use of tools and a system of checks and balances
* Develop a comprehensive understanding of all managed care contractual terms and reimbursement methodologies between NYU School of Medicine and external commercial payers
* Evaluate and escalate eligibility, authorization, billing, and claims processing inaccuracies to the appropriate CBO and FGP Operations Management in order to implement upstream resolution and re-education
* Assist with providing constructive feedback and developing training tools
* Work collaboratively with a variety of departments within NYU School of Medicine and externally with commercial managed care payers
* Learn appropriate new software systems to help analyze and evaluate claims dataWork independently, take initiative, and think critically
* Function with minimal supervision, request feedback appropriately, and initiate inquiries to gain additional understanding

What Does A Reimbursement Analyst Do At Minnesota Visiting Nurse Agency

* _
* Supports the preparation and audits of required Medicare and Medicaid annual reports and supporting schedules for HCMC to ensure they are accurately and timely filed
* Prepares all work papers in accordance with Medicare and Medicaid regulations and in such a way that HCMC’s appeal interests regarding program reimbursement are protected
* Prepares and files the Home Health and Hospice Medicare Cost Report
* Performs Monthly Bed Reconciliation
* Performs contract labor analysis
* Prepares and files annual Tricare/Champus report
* Maintain and update Medicare and Medicaid facility enrollment
* Review patient’s Medicaid eligibility in order to maximize reimbursement from government payers and create a database for retrospective and future reimbursement claims
* Prepare and assist with Medical Education Research Costs (MERC) report
* Assists in analysis of new federal and state legislation and its financial impact on HCMC
* Effectively communicate Regulatory changes through professional written and verbal skills
* Assist with various Hospital Surveys from outside organization
* Other duties as assigned, but only after appropriate training
*

What Does A Reimbursement Analyst Do At Pacificsource Health Plans

* Research, initiate and audit updates of published fee schedules for commercial and government lines of business.
* Research requests from internal and external customers on establishing fee allowances as appropriate for otherwise undetermined allowables and present recommendations to the Director of Provider Network.
* Perform regular reconciliation and administration payment processes for facilities, IPAs, provider groups and panels, and coordinate payments with Finance.
* Collaborate with Analytics on analyses projects, including, but not limited to, COB, contract renewals and initial negotiations and reimbursement trends.
* Communicate updates and trends to internal stakeholders.
* Responsible for invoice preparation, documentation and audit of provider network fees and capitation payments, as specified in agreements with provider groups, IPAs, provider panels and capitated entities.
* Work with Compliance Audit and Reporting Specialists to ensure post-claims audits are accurate, timely and consistent with PacificSource policies and procedures.
* Educate and train staff in reimbursement methodologies, payment policies and contract compliance.
* Develop policies and procedures related to duties.
* Supporting Responsibilities:
* Participate in department training and meetings as needed to become cross-trained and proficient in other areas of the department.
* Meet department and company performance and attendance expectations.
* Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
* Perform other duties as assigned.
* Qualifications

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How To Become A Reimbursement Analyst

Most management analysts have at least a bachelor’s degree. The Certified Management Consultant (CMC) designation may improve job prospects.

Education

A bachelor’s degree is the typical entry-level requirement for management analysts. However, some employers prefer to hire candidates who have a master’s degree in business administration (MBA).

Few colleges and universities offer formal programs in management consulting. However, many fields of study provide a suitable education because of the range of areas that management analysts address. Common fields of study include business, management, economics, political science and government, accounting, finance, marketing, psychology, computer and information science, and English.

Analysts also routinely attend conferences to stay up to date on current developments in their field.

Licenses, Certifications, and Registrations

The Institute of Management Consultants USA (IMC USA) offers the Certified Management Consultant (CMC) designation to those who meet minimum levels of education and experience, submit client reviews, and pass an interview and exam covering the IMC USA’s code of ethics. Management consultants with a CMC designation must be recertified every 3 years. Management analysts are not required to get certification, but it may give jobseekers a competitive advantage.

Work Experience in a Related Occupation

Many analysts enter the occupation with several years of work experience. Organizations that specialize in certain fields typically try to hire candidates who have experience in those areas. Typical work backgrounds include experience in management, human resources, and information technology. 

Advancement

As consultants gain experience, they often take on more responsibility. At the senior level, consultants may supervise teams working on more complex projects and become more involved in seeking out new business. Those with exceptional skills may eventually become partners in their consulting organization and focus on attracting new clients and bringing in revenue. Senior consultants who leave their consulting company often move to senior management positions at nonconsulting organizations.

Important Qualities

Analytical skills. Management analysts must be able to interpret a wide range of information and use their findings to make proposals.

Communication skills. Management analysts must be able to communicate clearly and precisely in both writing and speaking. Successful analysts also need good listening skills to understand the organization’s problems and propose appropriate solutions.

Interpersonal skills. Management analysts must work with managers and other employees of the organizations where they provide consulting services. They should work as a team toward achieving the organization’s goals. 

Problem-solving skills. Management analysts must be able to think creatively to solve clients’ problems. Although some aspects of different clients’ problems may be similar, each situation is likely to present unique challenges for the analyst to solve.

Time-management skills. Management analysts often work under tight deadlines and must use their time efficiently to complete projects on time.

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Reimbursement Analyst jobs

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Real Reimbursement Analyst Salaries

Job Title Company Location Start Date Salary
Reimbursement Analyst Sutter Health Support Services Sacramento, CA Oct 29, 2012 $95,000
Reimbursement Analyst Parkland Health & Hospital System Dallas, TX Feb 22, 2016 $83,491
Clinical Reimbursement Analyst RN Express Staffing Registry, LLC New York, NY Sep 30, 2015 $81,435
Clinical Reimbursement Analyst RN Express Staffing Registry, LLC New York, NY Sep 30, 2015 $80,433
Reimbursement Analyst Byram Healthcare Centers, Inc. White Plains, NY Jun 10, 2010 $75,000
Clinical Reimbursement Analyst RN Express Staffing Registry, LLC New York, NY Oct 01, 2012 $74,880
Senior Reimbursement Analyst Providence Hospital Washington, DC Oct 30, 2009 $71,000
Clinical Reimbursement Analyst The Charts Group LLC Lakewood, NJ Jan 20, 2014 $62,714
Institutional Reimbursement Analyst Blue Cross Blue Shield of Nebraska Omaha, NE Oct 02, 2012 $61,176
Reimbursement Analyst Adventist Health System Altamonte Springs, FL Oct 01, 2012 $50,305
Revenue and Reimbursement Analyst Accretive Health Inc. Chicago, IL Nov 01, 2011 $50,000 -
$60,000
Clinical Reimbursement Analyst Tender Touch Rehab Services LLC Lakewood, NJ Nov 18, 2011 $45,000

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Top Skills for A Reimbursement Analyst

FinancialStatementsMedicare/MedicaidAnnualCostReportsAuditInsuranceCompaniesFeeSchedulesHealthcareProvidersCpt-4FacilityAccountsReceivablesCustomerServiceRevenueCyclePatientAccountsPharmacyReimbursementIssuesSpecialProjectsMedicalRecordsDataEntryJournalEntriesProperReimbursement

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Top Reimbursement Analyst Skills

  1. Financial Statements
  2. Medicare/Medicaid
  3. Annual Cost Reports
You can check out examples of real life uses of top skills on resumes here:
  • Prepared monthly consolidated financial statements, balance sheet analysis, expense and revenue allocations for 28 facilities.
  • Analyzed hospital operating costs pertaining to Medicare patients in order to properly prepare and submit Medicare/Medicaid Cost Report to government agencies.
  • Prepared annual cost reports for Medicare and Medicaid, ensuring compliance with federal and state public welfare codes.
  • Coordinate resolutions of intermediary and state agency audits and communicate the status of those audits.
  • Executed meetings with insurance companies to resolve customer and contractual disagreements.

Top Reimbursement Analyst Employers