Reimbursement Analyst Resume Samples

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R Zieme

Randal

Zieme

19743 Laron Fort

Chicago

+1 (555) 588 4380

19743 Laron Fort

Chicago

Phone

p +1 (555) 588 4380

Experience Experience

New York, NY

Reimbursement Analyst

New York, NY

Kuhn, Klein and Wolff

New York, NY

Reimbursement Analyst

Develop analysis and reports to support the managed care team in evaluating PBM and contract performance
Identify defects and improve accurate provider payment by performing root cause analysis on specific examples through each step of the Claims Process
Quantifies data to assist in developing reports, to determine the financial impact of claims processed by pharmacies
Utilize knowledge of areas related to Claims, e.g. Network, Benefits, Authorizations, Provider Operations, Finance, and Enrollment
Promote personal and co-worker safety during work duties
5) Tracks and trends denials and underpayments by adding user codes in the contract management systems in order to communicate with management
Quantifies data to assist in developing reports, to determine the financial impact

Houston, TX

ESC Expense Reimbursement Analyst

Houston, TX

Kiehn Group

Houston, TX

ESC Expense Reimbursement Analyst

Performs source cause reviews of unit related data and develops action plans to reduce exception levels
Makes compliance related judgments and recommendations based on the analysis of factual information and proposes solutions to direct manager
Review expense reimbursement postings to back-end system and work to resolve posting issues with system support team
Review and perform expense policy compliance on urgent T&E reports for North America
May occasionally provide informal guidance or on-the-job-training to new team members
Reviews and processes Tier Two service tickets for North America Expense Reimbursement process
Process manual terminated expense reports when volumes dictate

present

Philadelphia, PA

Senior Reimbursement Analyst

Philadelphia, PA

Terry, Kerluke and Kessler

present

Philadelphia, PA

Senior Reimbursement Analyst

present

Assist with month-end close including preparation of journal entries
Prepares annual cost reports work papers for Medicare, Medicaid, Blue Shield and CHAMPUS. Prepares summaries and analyzes annual expenses, revenues, and statistics for properly filing on all annual cost reports
Analyzes the performance of Medicare and Medicaid reimbursement methodologies and regulatory changes
Prepares net revenue journal entries and assists the Regional Director of Reimbursement with various account reconciliations of general ledger to RCA and the monthly/year-end financial statements
Assist with budget process
Ad hoc requests
Coordination and filing of third party cost reports

Education Education

Bachelor’s Degree in Accounting

Auburn University

Bachelor’s Degree in Accounting

Skills Skills

Excellent interpersonal skills; ability to work well within a team environment
Strong analytical skills and attention to detail
Excellent oral and written communication skills
Strong analytical, evaluative and statistical skills
Ability to handle shifting priorities and multiple projects simultaneously
Knowledge of third party reimbursement processes
Knowledge and understanding of coding and Medicaid regulations, medical insurance billing concepts: UB/2360/1500
Detail Oriented and proactive with resolving data anomalies
Strong reading and comprehension abilities to understand and interpret complex laws and regulations issued by CMS and California DHS such as Medicare and Medicaid regulations published in the Federal Register
Experience with relational databases and knowledge of query tools and/or statistical business intelligence software (Micro Strategy) is beneficial

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Medicaid Reimbursement Analyst Resume Examples & Samples

50%: Process Rebates invoiced to Shire under the MDRP, including Federal Medicaid, Manage Care Medicaid (MMC), State Pharmaceutical Assistance Programs, State Programs (i.e. Texas Chip) and Federal and State Supplemental programs. Analyze and report via The State Assessment Form for each state program for both trends and disputable anomalies
20%: Prepares and provides standard Medicaid rebate reports and trend analysis to Government Affairs Group in the field and home office management. These reports include state utilization trending, claim receipt status, reconciliation of state invoice and ad-hoc reporting. Evaluate submissions for accuracy and combined MMC data according to new requirements outlined in the Affordable Care Act of 2010
10%: Acts as company liaison with various state Medicaid agencies and other program offices via analyzing and resolving disputes
10%: Review and update rebating system with updated contract terms and prices. Maintains knowledge in operation of Imany® Medicaid Rebate Processing system
10%: Tracking and documenting payments to respective Medicaid agencies and other program offices. Ensures compliance with all state mandated due dates and avoiding interest penalties at all times

ESC Expense Reimbursement Analyst Resume Examples & Samples

Reviews and processes Tier Two service tickets for North America Expense Reimbursement process
Review and perform expense policy compliance on urgent T&E reports for North America
Process manual terminated expense reports when volumes dictate
Support the FRO Reconcilement Unit in resolving any outstanding T&E exceptions
Makes compliance related judgments and recommendations based on the analysis of factual information and proposes solutions to direct manager
Performs source cause reviews of unit related data and develops action plans to reduce exception levels
Support Information Center tasks when required
1-2 years business experience. College degree preferred
Able to meet deadlines and production numbers

Reimbursement Analyst Resume Examples & Samples

Must have experience in healthcare, auditing, working, analyzing and completing Medicare cost reports (CMS Form 2552-96 and CMS Form 339), and Medi-Cal cost reports with related supplemental schedules (A & I Forms). Must have knowledge in the application and treatment of revenues and expenses, and various payment methodologies used by the Medicare and Medi-Cal programs. This level is typically obtained in 3 to 4 years of direct experience
Must have the experience and thorough understanding of the correct application and calculation of Medicare and Medi-Cal entitlements, applying current Medicare and Medi-Cal laws and regulations governing facility entitlements under Title XVIII and Title XIX for Acute Hospitals, Skilled Nursing Facilities (SNF), Home Health Agencies (HHA), Rural Health Clinics (RHC), Psychiatric Hospitals, Rehabilitation Units, and hospitals with medical education and organ transplant programs
Must have experience working and understanding the hospital accounting systems, accrual basis of accounting, audit processes, and working paper presentation and cross-referencing
Must have experience in the application and use of licensed Medicare/Medi-Cal cost report software programs
Must have a good understanding of accounts receivable valuation methodologies and calculation of contractual allowances
Must have experience using personal computers and related software applications such as (a) spreadsheets, (b) word processing, (c) e-mail and (d) cost reporting software. Experience with the MedSeries4 mainframe system is considered a plus
Must be knowledgeable and understand all of the Medicare and Medi-Cal compliance cost reporting requirements
Must be knowledgeable and understand the laws and regulations governing Medicare and Medi-Cal reimbursement affecting Acute Hospitals, Psychiatric Hospitals, Physical Rehabilitation Units, SNF, HHA, RHC, and inpatient and outpatient payment systems under Title XVIII and Title XIX of the Act
Must be knowledgeable and understand hospital accounting system and the accrual basis of accounting
Must know how to use personal computer and related applications such as (a)spreadsheet, (b) word-processing (c) e-mail and (d) cost reporting software application. Knowledge of the MedSeries4 system is considered a plus
Must know how to write brief and concise reports
Must know how to create and cross-reference working papers with supporting documents
Must know and understand how to apply and use statistical models
Strong written, verbal and interpersonal and presentation skills
Strong reading and comprehension abilities to understand and interpret complex laws and regulations issued by CMS and California DHS such as Medicare and Medicaid regulations published in the Federal Register
Strong analytical, evaluative and statistical skills
Ability to handle shifting priorities and multiple projects simultaneously
Must have the ability to adhere to critical deadlines
Must be knowledgeable and efficient in the use of personal computers and related applications
Must be able to work with very minimum supervision

Prin Reimbursement Analyst Resume Examples & Samples

Degree in Economics or Health Economics or Bioscience (including Medicine, Pharmacy, Biostatistics)
Ideally, post-graduate qualification in health economics, biostatistics, public health, epidemiology or other relevant field
At least 5 years of experience in similar position (health economist, bio statistician) in pharmaceutical, medical device industry ideally within spine industry
Experience with strategic value story development
Good understanding of the application and value of health economic modelling
Proven track record of experience within a regional/international headquarter conducting outcome research projects
Fluent in English; knowledge of other European languages is considered as a plus
IT: Proficient user of Microsoft programmes (Word, Powerpoint, Excel)

Senior Reimbursement Analyst Resume Examples & Samples

Prepares financial reports and conducts comprehensive analyses with written summaries to management
May be accountable for the coordination, compilation and distribution of financial data
Performs financial analysis upon identification of variances, and coordinates with junior analysts' variance analysis process as defined
Participates in the planning and development of regional, departmental and/or functional budgets
May be responsible for budget system completion and high level reviews
Participates in and/or leads projects of moderate to complex scope as assigned
Responsibilities impact the achievement of key department and/or functional objectives
Contributes to the achievement of department objectives
Erroneous decisions or failure to achieve department objectives would normally affect expenditures and resources
Involves interpreting and analyzing established concepts
Exercises judgment to make decisions for less defined issues and selects methods and techniques for obtaining solutions
Requires moderately complex decision-making
Develops solutions to complex problems
May refer to established precedents and policies
Requires significant analysis to develop solutions for complex problems
Provides professional/technical guidance to team members
Influences others regarding existing concepts, processes and/or methodology
Strong oral, written and presentation communication skills
Works under limited direction
Plans/schedules job activities to work toward accomplishing set objectives
Work is reviewed by management at key intervals for advice and guidance prior to completion
Typically five (5) to eight (8) years financial analysis or related experience
Bachelor's degree in finance related field or equivalent experience
Broad application of financial analysis principles, theories, and concepts in applicable discipline, plus working knowledge of other related fields
Advanced proficiency in PC based word processing and spreadsheet applications, including advanced functions such as graphics, pivot tables, macros and database management
Thorough knowledge of financial analysis policies, practices and systems
Complete understanding and application of financial analysis principles, concepts, practices, and standards
Highly developed knowledge of finance theories such as present values theory/cash flow analysis and accounting principles
Able to formulate finance study designs and prepare and conduct professional presentations
Full knowledge of industry practices and standards
Reimbursement experience to include multi-hospital cost report preparation
Audit experience in a regulatory environment
Experience with HFS and other reimbursement applications
Experience in compliance activities
CPA/CMA

Regional Reimbursement Analyst Resume Examples & Samples

Engage in the researching and analysis of product coverage, coding and reimbursement for sites of care: sourcing policies and procedures, information on hospital quality metrics, as well as quality outcomes databases and peer reviewed articles for reimbursement overview on products and services in the medical device space
Assist with the development and implementation of strategic presentations to internal and external stakeholders using extensive marketing skills
Employee on-boarding: development of new sales hire training documents and feedback for ensuring required new employee compliance with reimbursement protocols
Customer field visits, attend industry conferences & developing Key Opinion Leaders (KOL) relationships
Develop tactical resources such as reimbursement billing guides and sales tools
Prioritize existing products for market access-related opportunities such as enhancement of payment levels, direct payer contracting, or leverage of strategic product positioning that capitalizes on payment system nuances
Identify and leverage evidence that justifies value-based payments
Collaborate with sales and marketing teams to identify and resolve reimbursement obstacles and trends
Prepares and presents health economics data that provides insight into key improvement opportunities
LI-VH1
BA/BS in Health policy or related field
Medical coding certification: CPC, RHIA, HIT
2-4 years of healthcare business experience
Proficient with Microsoft suite, including Word, PowerPoint, Access, Excel, and Outlook
Experience in contributing to growth through securing favorable reimbursement status for key products in medical/pharmaceutical/biotech companies
Demonstrated capability and experience working on reimbursement/managed care teams
Comprehensive knowledge of direct reimbursement and payment systems and the various mechanisms of reimbursement and how they affect customer buying decisions
Understanding of payment policy issues
Superb attention to detail, with proficient skills in researching health care policies and data in government and commercial entities
Strong proofreading and editing skills
Proficiency in Microsoft applications especially PowerPoint, Outlook, Excel and Word
Proficient knowledge of US Healthcare is needed
Hands on exposure to clinical setting preferred

Reimbursement Analyst Resume Examples & Samples

3-5 years of Billing/Chargemaster/Auditing healthcare experience
Medical terminology background
H.S. diploma/equivalent required; associates/bachelors degree preferred

Cost Reimbursement Analyst Resume Examples & Samples

Two (2) years of experience working in Substance Abuse Recovery Programs
Expert-level proficiency with Enterprise Contracts Management System (ECMS)
Expert-level proficiency with Offender Management Network Information (OMNI)
Expert-level proficiency with OnBase
Advanced-level proficiency with Microsoft SharePoint, Word, Outlook, and Excel
Basic-level knowledge of American Study of Addiction Medicine Levels of Care and Diagnostic Service Manual, 5th Edition
Demonstrated ability to read and interpret contracts, state and federal laws and regulations, policies and procedures
Demonstrated effective written/oral communication and analytical skills
Familiarity with Medicaid requirements and guidelines
Demonstrated knowledge of Substance Abuse Terminology
Demonstrated experience and understanding of evidence-based treatment delivery practices

Reimbursement Analyst Resume Examples & Samples

Required to have performed routine product reviews to identify issues and areas for improvement
Required to have the knowledge of processing data for analysis (cleansing, modifying, and formatting) and mapping data across various systems
Required to have the ability to compile periodic reports with metrics by product, detailing issue category, frequency, cause, preventive recommendations and trends
Required to have the ability to provide QA support by finding data problems in any data repository including spreadsheets, spreadsheet formulas and SQL Server tables

Reimbursement Analyst Resume Examples & Samples

Calculates periodic adjustments for deductions from revenue, revenue reserves, bad debt and other revenue adjustments related to regulatory reimbursement for all Dignity Health facilities and regions in accordance with Dignity Health policies and procedures
Assist the Reimbursement Sr. Analysts, Managers and/or Directors with recommendations for internal Dignity Health strategy by evaluating current growth, anticipating future needs, and assessing impact of services delivered
Assists in the maintenance of standardized policies and procedures and third party settlement methodologies
Assist in analyzing the impact of regulatory developments and participate in implementing necessary changes
Assesses the impact of new products, technology, and processes on the existing organization and makes recommendations for improvement
Commitment to Dignity Health Values
Customer Orientation
Reasoning
Medicare
Medicaid Regulatory Reporting
Accounts Receivable and Cash Collection
Capital and Fixed Assets
Reimbursement – Monthly Analysis Process
Minimum of one year experience and excellent working knowledge of general accounting or finance and information systems
Minimum of one year experience with all aspects of Medicare and Medicaid regulations is desired but not required
Bachelor’s degree with emphasis Accounting, Finance or equivalent work experience required

Reimbursement Analyst Resume Examples & Samples

Assist with providing explanations of existing reimbursement policies and analysis regarding third party reimbursement and regulatory changes that impact payments and operations
Maintain payor and procedure tables in billing system
Design and generate data queries to extract specific information from the billing system for clients and operational staff
Perform payor policy research and analysis
Resolves accounts receivable requests and billing discrepancies
Generates fee schedules, cash-per-visit analysis, and impact analysis, as needed

Reimbursement Analyst Resume Examples & Samples

Reviews and analyzes final payment rates submitted by third party payors and governmental agencies for accuracy
Participates and recommends areas where formal appeals to third party and government agencies are warranted
Maintains in-depth and current knowledge of Medicare, Medicaid, managed care and other third party payors regulations
Identifies, analyzes, and recommends enhancements to policies that correspond with Medicare regulations for maximum reimbursement
Analyzes all third party payor claim denials for appropriateness
Reviews all Peer Review Organization denials for Medicare and Medicaid and formulates formal responses
Verifies documentation, notifying Coding/Compliance Consultant of billing discrepancies and verifies correct payment after denials have been reversed
2 years college preferred
CPC certification preferred
3 years medical reimbursement/claims denial experience
Extensive knowledge of Medicare, Medicaid, and third party reimbursement rules and regulations, contractual adjustments and interpretation of third party payor EOBs
Must be able to communicate effectively in English

Senior Reimbursement Analyst Resume Examples & Samples

Prepares interim and annual cost reports for Medicare, Medicaid and other State or Federal agencies for Dignity Health facilities and regions
Assist the Reimbursement Managers and/or Directors with recommendations for internal Dignity Health strategy by evaluating current growth, anticipating future needs, and assessing impact of services delivered
Reviews operational reports, identifies opportunities/problems, and makes recommendations for improving processes
Communication Ability
Medicare Regulatory Reporting
Medicaid (Medi-Cal)
Medicaid (Medi-Cal) Regulatory Reporting
Minimum of five years experience with all aspects of Medicare and Medicaid (Medi-Cal) regulations monitoring and report processes required. Experience as hospital Reimbursement staff or auditing experiences with Fiscal Intermediary required
Minimum of five years experience and excellent working knowledge of general accounting, government reimbursement, appeals and audits in a complex organization, and maintaining relationships with internal and external entities such as general accounting, patient accounting, and fiscal intermediaries required
Experience and knowledge of current reimbursement regulations and applications in a complex healthcare environment required
Bachelor’s degree in Business Administration, Accounting or equivalent work experience required

Medicaid Reimbursement Analyst Resume Examples & Samples

Bachelor's Degree or 2 years relevant work experience. College level credits in Finance, Accounting or Computer related studies will benefit the candidate
Experience with Revitas, Government Pricing/CARS IS/Medicaid suite, Model N® Government Pricing application strongly preferred
Experience with Microsoft Excel and Access required
Experience with any other government contract discount and rebate management systems preferred
Experience with SAP and SQL a plus. Must know Medicaid Drug Rebate Program regulations, guidelines, and current updates

Cost Reimbursement Analyst Resume Examples & Samples

Associate's degree from an accredited college or university whose accreditation is recognized by the U.S. Department of Education or the Council for Higher Education Accreditation (CHEA)
Ability to conduct analysis using Excel, developing complex formulas and creating PivotTables
A minimum of one (1) year experience in a professional or educational environment conducting research and/or analyzing policies, laws, rules, or regulations
The following proficiencies in Microsoft Office Suite
Bachelor's degree in business or public administration or a relevant field from an accredited college or university whose accreditation is recognized by the U.S. Department of Education or the Council for Higher Education Accreditation (CHEA)
Ability to analyze and interpret data; write clearly and concisely; prepare professional reports and work on a variety of tasks with frequent interruptions
Working knowledge and understanding of the agency, in particular the Health Services Division, medical terminology, and provider specialties
Recent work experience performing complex financial and statistical analysis and analysis of medical, pharmaceutical, and/or mental health related data

Cost Reimbursement Analyst Resume Examples & Samples

Manages one or more major programs relating to professional and/or hospital reimbursement systems
Directs development of legislative proposals, fiscal impact statements, and department positions in judicial proceedings
Directs development and adoption of administrative regulations establishing or modifying major reimbursement systems
Understands and interprets program rules and regulations for operationalizing program reimbursement processes, and keeping abreast of changes that have program implications
Demonstrated ability to manage a comprehensive workload that includes sound reasoning and logical decision making
Good computer skills and experience, especially with Microsoft WORD and EXCEL
Ability to multitask and easily adapt to changing priorities as a result of working in a high pressure environment
Ability to objectively assess and processes situations, recommend balanced and effective solutions from an objective viewpoint, and help others see the benefit of those solutions
Demonstrated ability to complete work accurately within the mandated deadlines
Current resume

Reimbursement Analyst Resume Examples & Samples

Proven experience with Medical Billing Analysis
Detail Oriented and proactive with resolving data anomalies
Prior analytical experience in healthcare insurance industry strongly preferred

Value Based Reimbursement Analyst Resume Examples & Samples

Provides analytical support for value-based programs (QBRP, PCMH, and ACO), including independently monitoring/measuring the performance of the initiatives by leveraging utilization, financial, clinical, and benchmark data from multiple internal and external sources. Will perform analysis, summarize results, and oversee value-based payments while adhering to established standards and processes
Directly communicates and assists providers in value based programs (QBRP, PCMH, and ACO). Communication will include inquiries on member attribution, system out-migration reporting, reporting progress on value metrics, training providers how to use the Value Based vendor software which is accessible by the provider , ad hoc reporting on potentially preventable admissions, readmissions, emergency room visits, and ancillary services, and other reporting needs identified through daily communication with value based programs. As the position directly communicates with the value based programs, it is critical the correct information is shared
ACO measures the total cost of care as a per member per month for attributed members. Must provide reporting on lines of business included in total costs of care (professional, outpatient, inpatient, and drug costs)
Utilize various software packages to extract, compile and present strategic recommendations
Conducts data validation testing of VBR source data to assure accuracy and reliability. Develop test data for each request that will be utilized to document test scenarios pertaining to a specific requirement
Uses prescribed techniques, analyzes, compiles, and summarizes tested data to identify problem areas related to insured health care use and trends. Prepare recommendations for course of action. Maintain all documentation associated with testing and be able to retrieve it as required
Investigate problems with software applications as they are identified, determine solutions and evaluate the need to take action. Perform the appropriate procedures to resolve the problems
Document user stories, assist with sprints, and maintain appropriate records in Agile, Team Track, and applicable software. Consult with the Information Services whenever assistance or clarification is needed for a PAR or Project. This includes providing specifications of the changes that are required. Review projects submitted regarding systems or operating environments to determine any impact to systems or software application. Communicate any possible changes that are needed
Attend outside resources meetings with external partners, as needed, for corporate projects, supervision, or management. Assist with data or software application related inquiries
Stays current on health care and health industry developments on best practices and initiatives in developing new provider payment and network models to support more coordinated, efficient and quality-driven healthcare
Independently translate and prepare ad hoc analysis of raw data files based on requests from all levels of management, external partners, and from people having varying degrees of data processing expertise
Serve on corporate teams and projects, as assigned to implement governmental mandated requirements and corporate systems, programs, and policies with effective results
Work with Professional Relations, Institutional Relations, and Provider Reimbursement as needed to develop annual Maximum Allowable Payments (MAPs). Prepare ad hoc reports as needed
Must work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers
Working conditions are adequate. Ability to key and use personal computer and mouse up to 90% of the day is required. May require travel to other office locations. Requires ability to withstand frequent and intense pressure as a result of demanding workload and must be able to handle in a positive and professional manner
High school graduate or equivalent with high aptitude in math and analytical skills
Must have 12 hours of college business coursework, data analytics, or related areas of study. Preferred Bachelors Degree in business administration, economics, data analytics, or related field. Education may be substituted with 5 years data analytics experience
The ability to understand and work with corporate tools such as Excel, Access, Word, QMF, and Focus to audit data or research databases. Basic skills and ability to operate a ten-key calculator required. Ability to type 40 wpm preferred
Minimum one year experience communicating with providers, external partners, or in a customer service capacity preferred
Must be familiar with DB2 database structures and have the ability to extract data from them. It is preferred to have previous experience with MASK, SWIFT, BEACON, TSO, ACES and CSI
Must have the ability to effectively communicate, advise, consult, and negotiate with all levels of internal and external staff. Must be able to diplomatically resolve differences
Must be able to maintain a high degree of accuracy of own work, honesty, loyalty, integrity, and confidentiality
Understanding of agile development methodologies, value and procedures a plus
Must be able to deal with a high degree of system complexity and detail
Must be able to work independently and prioritize assigned work to ensure the items with a high impact are resolved first and to meet critical deadlines
Critical thinking and problem analysis skills required
Must be able to work both independently and in a team environment to prioritize assigned work to meet critical deadlines
Demonstrates high degree of initiative, organization, clarity, flexibility and urgency in managing workload and resources
Must be able to intelligently evaluate over hundreds of benefits combination, organizational policies and procedures
Must be willing to learn additional applications that will aid in performance of this position
Coding, coverage, and reimbursement methodology knowledge is preferred. Data processing knowledge is preferred
Preferred general knowledge of physician and hospital operations including hospital/medical economics/practices, insurance, and health products

Senior Reimbursement Analyst Resume Examples & Samples

Coordination and filing of third party cost reports
Calculation and recording of monthly net revenues using contractual models
Assessing reimbursement impacts of changes in regulations and/or contracts
Prepare reconciliations and work papers of balance sheet accounts for financial audits
Respond to third party audit requests
Maintain knowledge on reimbursement regulations
Analyze third party settlements and correspondence
Master’s Degree, preferred
Three to five (3-5) years of reimbursement experience including preparation, audit or review of hospital cost reports
General knowledge of third party reimbursement mechanisms
Strong Analytical reasoning and problem solving skills are highly preferred
Must be proficient with Microsoft Access and Excel

Reimbursement Analyst, Senior Resume Examples & Samples

Analyze and review all third payer CRA accounts, Report any discrepancies or inaccuracies to appropriate management personnel in order to maintain the integrity of the financial statements
Analyze and review government third party interim payment rates and prepare data submission to third party payers to update interim payment rates and report interim rate updates to corporate and facility departments
Conduct sensitivity studies and analyses involving healthcare reimbursement impacts and compliance as well as assess and calculate reimbursement potential for new provider services and making recommendations to management based on these studies
Maintain an ongoing understanding of government regulations as they relate to reimbursement issues, analyze the impact of these regulations and apply these to the documentation that is maintained for the preparation of the third party cost reports
Perform other related third party reimbursement responsibilities as required by manager
Prepare appeals, or other required information for third party payers
Prepare third party cost reports for fiscal year end and acts as support to all other reimbursement departments at facilities within UPMC
Responsible for a clear and thorough understanding of the cost report software to ensure its efficient and accurate use. Also maintain backup files of all old and new software versions to ensure our ability to restore return and revise prior cost reports due to audit or appeal circumstances
Responsible for handling financial and third party government audits
Responsible for key Revenue Enhancement initiatives such as the Disproportionate Share, IME, GME, Wage Index, Transplants and Physicians which account for large reimbursement dollars
Review, analyze and document all third party audit adjustments, recommending either acceptance or rejection of those adjustments, and if necessary, preparing appeals and position papers related to those audit adjustments
Supervise several projects and related staff at same time
Train and assist in the training of Associate and Intermediate Analysts
Bachelors Degree in Accounting or Advanced Financially Related Degree
OR 8 years experience in a job related equivalent in the Reimbursement Field or Health Care Finance Field is required

Senior Reimbursement Analyst Resume Examples & Samples

Maintains the current revenue analysis and reporting application, Revenue Cycle Analytics (RCA) for the purpose of valuing the region’s patient accounts receivable (AR). Maintains accounts receivable settings, such as zero balance and hindsight date ranges, discount type settings, and valuation percentage analysis. Generates reports from the RCA application and critically examines the information to ensure timely and accurate AR valuation
Analyzes and communicates to the Regional Director of Reimbursement significant monthly, quarterly, and annual changes in AR valuation especially as it relates to setting changes in the RCA application
Prepares net revenue journal entries and assists the Regional Director of Reimbursement with various account reconciliations of general ledger to RCA and the monthly/year-end financial statements
Analyzes the performance of Medicare and Medicaid reimbursement methodologies and regulatory changes
Prepares annual cost reports work papers for Medicare, Medicaid, Blue Shield and CHAMPUS. Prepares summaries and analyzes annual expenses, revenues, and statistics for properly filing on all annual cost reports
Bachelor's degree in Accounting, Finance, or related field required. Five years of experience in a financial analysis role required. Experience in healthcare setting and/or Public Accounting is preferred. Experience with data analysis and strong analytical capabilities skills required
CPA/MBA preferred. Knowledge and understanding of third party reimbursement principles and regulations is preferred
Proficient with Microsoft Office software including Excel, Word, PowerPoint, and Access. Prior experience with Meditech, EPIC, Monarch, Crystal Report Writer, RCA application, and cost reporting software is preferred

Reimbursement Analyst, Assoc Resume Examples & Samples

Assist in the Revenue Enhancement initiative with emphasis on the Disproportionate Share Initiative
Assist in the preparation of appeals, or other required information for third party payors
Assist with the preparation of the third party cost reports for fiscal year end
Comply with cross training efforts to develop back up personnel with knowledge of more complex departmental procedures
Follow departmental procedures to ensure proper accumulation of all monthly statistical data to complete accurate reports. Data collected includes but is not limited to patient days, cost allocation statistics, patient revenue, discharges, organ acquisition summaries, payment data and time studies
Perform and or assist in sensitivity studies and analyses involving healthcare reimbursement impacts and compliance
Prepare third party cost reports at fiscal year end. Maintain an ongoing understanding of government regulations as they relate to reimbursement issues, analyze the impact of these regulations and apply those regulations to the necessary documentation that is needed for the preparation of the third party cost reports
Responsible for a clear and thorough understanding of the cost report software to ensure its efficient and accurate use. Also maintain backup files of all old and new software versions to ensure our ability to restore, return and revise prior cost reports due to audit or appeal circumstances
Review third party government regulations to ensure a complete understanding on the rationale or mandates behind the third party cost report procedures
Bachelors Degree in Accounting or Advanced Financially Related Degree or 4 years experience in a job related equivalent in the Reimbursement Field or Health Care Finance Field is required

Reimbursement Analyst Resume Examples & Samples

Assists in preparation, evaluation and maintenance of processes in support of regulatory and third party updates including quarterly workpapers, annual audits, cost accounting and third part 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

Reimbursement Analyst Resume Examples & Samples

Demonstrate support of the Agency's Mission, Principles, and Values, Ethics, & Standards of Behavior
Educate and require adherence to performance improvement processes and initiatives
Expand knowledge and expertise through educational resources and literature review
Maintain and protect customer and Agency confidentiality
Maintain personal productivity by demonstrating satisfactory attendance and punctuality
Manage specific customer receivable accounts Monitor customer account details for non-payments, delayed payments, and other irregularities Initiate communication with customers and payers to: Negotiate payment plans and account adjustments Resolve inaccuracies and/or provide additional information Investigate and resolve issues with Agency program staff, using the Billing Communication system Collaborate with Agency Accountants to investigate and resolve account issues Reconcile, adjust and allowance accounts, according to Agency guidelines Apply cash payments and allowances to relieve customer accounts, according to Agency procedures
Obtain and maintain current knowledge of The requirements, standards, practices, and preferences of the Agency services The requirements, standards, practices, and preferences of the payers of those services The computer systems used to manage reimbursement and customer records
Prepare and submit billing statements in electronic and paper formats Review billing statements for coding, pricing, and service accuracy Resolve inaccuracies prior to submitting the statement, using the Billing Communication system Submit accurate and timely billing statements that meet the requirements of each specific payer
Promote personal and co-worker safety during work duties
Provide non-account specific support Prepare bank deposits Respond to customer requests for information and customer account records Assist in Agency financial and program audits, as needed Maintain accurate filing and record systems Create regular and periodic reports as needed or requested
Represent and participate in Agency professional and community activities as requested

Reimbursement Analyst Resume Examples & Samples

1) Utilizing the contract management system reports, identifies inappropriate payments from the various payers
2) Writes appeal letters and creates corrected claims to recover payments on underpaid claims
3) Understands and utilizes standard and ad hoc reports from a wide variety of systems to identify, analyze, appeal, track and follow up on incorrectly reimbursed claims
4) Reviews and approves refund requests received from a variety of internal and external sources
5) Tracks and trends denials and underpayments by adding user codes in the contract management systems in order to communicate with management
6) Audits new contracts and term updates for accuracy
7) Participates in and completes projects as assigned by manager
8) Attends meetings as required
9) Maintains strict adherence to the Lahey Clinic Confidentiality policy
10) Incorporates Lahey Health Guiding Principles , Mission Statement and Goals into daily activities
11) Complies with all Lahey Clinic Policies
12) Complies with behavioral expectations of the department and Lahey Clinic
13) Maintains courteous and effective interactions with colleagues and patients
14) Demonstrates an understanding of the job description, performance expectations, and competency assessment
15) Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards
16) Participates in departmental and/or interdepartmental quality improvement activities
17) Participates in and successfully completes Mandatory Education
18) Performs all other duties as needed or directed to meet the needs of the department. Qualifications Minimum Qualifications

Reimbursement Analyst Resume Examples & Samples

Assists in creation of reports and facilitates data requirements needed to extract and compile data to identify compliance by the PBM
Analyze reimbursement and MAC cases to identify opportunities to improve network pharmacy reimbursement. Identify claims that resulted in a high loss
Develop analysis and reports to support the managed care team in evaluating PBM and contract performance
Provide reports to track Brand/Generic and 30 day/90 day profitability comparisons and trends
Quantifies data to assist in developing reports, to determine the financial impact of claims processed by pharmacies
Provide prospect pharmacy profitability reports as needed by managed care team
Ensure completeness and accuracy of Manufacturer NDC prefixes in the Hub data for downstream use by other teams
Maintain specialty drug list for use by other teams in analytics and reports
Develops reporting to identify specific reimbursement trends related to both Brand and Generic items and prepares written reports detailing the results
Quantifies data to assist in developing reports, to determine the financial impact
Identifies data quality issues including errors relative to data validity and completeness and ensuring timely resolutions
Continually works to develop the specifications for ad hoc report requests and enhancements to existing reports
Maintains data related to PRxO Generics and Pricing information to ensure changes are implemented in all reports current and future
Knowledge of Pharmacy environment
Ability to work independently with general direction
Ability to convey results of analysis in a easy-to-follow format
Proficient in Microsoft Office Excel, Access, Word and Power Point
Experience with relational databases and knowledge of query tools and/or statistical business intelligence software (Micro Strategy) is beneficial

Contracting & Reimbursement Analyst Resume Examples & Samples

Minimum 5 years’ experience
Experience should consist of increasing levels of responsibility with a demonstrated ability to work effectively with senior healthcare executives, insurer advocacy groups and physicians
Additional experience with procedure codes and health plan products is highly desired
Experience in Healthcare Reimbursement and Contracting, highly desired

Reimbursement Analyst Resume Examples & Samples

Act as company expert on all reimbursement issues
Analyze all reimbursement, including outliers, transfer adjustments, etc
Analyze and compare fee schedules
Attend meetings when required
Complete special projects accurately and timely
Monitor Calendar to assure all action items are completed proactively
Monitor and review new pricing configuration to assure the provider is pricing accurately as contracted. This includes maintaining documentation of your review
Out of network negotiations when required
Resolve problems that result in claims pending
Resolve reimbursement issues
Update and maintain hospital reimbursement rate summary
Update and maintain hospital reimbursement reports for all product lines. Reports include inpatient base rate comparisons, outpatient reimbursement comparisons to UPMC OP fee schedule, Observation cost per case
Work with Reimbursement Specialist in developing / negotiating reimbursement rates for new providers. Including accurate, easy to understand analysis of the negotiated rates
Work with configuration staff when negotiating to assure negotiated rates are operational
Bachelors Degree in health care administration, business and/or other related discipline (Related experience in a health care administration setting may be substituted for educational requirements)
Advanced mathematical skills
Ability to interpret and summarize results of various analysis in a timely and meaningful way
Strong computer skills, including expert knowledge of Access and Excel
Experience with a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is preferred
Preferred individual needs to have in depth understanding of managed care delivery systems and have had direct experience with reimbursement
Knowledge of ICD-9CM, CPT4, Revenue Codes, DRGs, base rates, Medicare methodologies, Medicaid methodologies, HCPCS coding and related governmental guidelines and provider reimbursement methodologies preferred
Ability to work cooperatively with multidisciplinary teams and/or independently

Reimbursement Analyst Resume Examples & Samples

One to two years of high volume medical billing and/or insurance claims processing experience required
One to two years of customer service experience preferred
Knowledge and understanding of coding and Medicaid regulations, medical insurance billing concepts: UB/2360/1500
Knowledge of third party reimbursement processes

Reimbursement Analyst Resume Examples & Samples

Develops weekly/monthly scheduled finance and billing reports
Generates ad-hoc finance and billing reports when requested
Performs analysis of variance reports that includes pay rates, receivables and trends
Researches and documents any questionable item causing the denial or underpayment of claims and makes efforts to appeal, re-bill or seek solutions for future improvements
Collects all necessary information for proper charge entry and billing; reconciles dollar amounts on batch reports; adds diagnosis codes or corrects missing/incorrect elements to submit electronic billing (invoicing)
Performs follow-up with insurance companies, workers compensation payers, other third party payers, medical groups, outside hospitals, and physician’s offices to ensure timely payments of patient bills in accordance with the terms and conditions of each contract and/or insurance company policies
Communicates with physician and other clinical staff to share guidelines of billing regulations, to ensure compliance and maximum reimbursement of services
Recommends process changes which would resolve ongoing billing problems, streamline the billing process, decrease the number of retrospective authorizations, enhance patient satisfaction, and maximize cash flow to the clinics
Collects and reconciles payments (from self-pays or third party payers) on overdue accounts. Ensures that payers adhere to compliance laws regarding timely processing of claims
Adapts to changes in the departmental needs including but not limited to: offering assistance to other team members, floating, adjusting assignments, etc

Senior Reimbursement Analyst / Umms Resume Examples & Samples

Prepares all required supporting schedules in accordance with the Center for Medicare and Medicaid Services (CMS) to complete the Medicare Cost Report for assigned facilities
Prepares routine internal reports for management review to ensure accurate revenue booking and compliance are achieved for assigned facilities. These reports include but are not limited to Volume & Price Report, Unit Rate Compliance Report, 8th and 10th Day Month-End Close Reports
Analyzes unit rate and charge-per-case compliance to ensure assigned facilities maintain compliance in accordance with HSCRC and CMS regulations. Recommends and ensures implementation of necessary price changes
Identifies reimbursement reporting opportunities designed to improve operational efficiency and reimbursement under current HSCRC policies and regulations. Assists managers and directors in developing protocols and documenting procedures
Communicates with departments within Shared Services and at assigned facilities in order to proactively identify opportunities for data integrity improvement
Acts as coordinator for gathering data and reviewing required analysis at the request of audit staff for annual financial statement audit, quarterly agreed-upon procedures and HSCRC special audit
Using fundamental knowledge of UMMS accounting, decision support and charge capture for multiple facilities, performs complex and intricate financial modeling for the development of internal reports/analysis that assists management with making operational decisions
Works closely with UMMS decision support and financial planning personnel to develop revenue projections and estimated rates for the development of annual revenue budgets for assigned facilities. Maintains and develops budget models that accurately calculate and incorporate all HSCRC rate factors and methodologies
Represents department on special internal and/or external committees or task force to develop procedures and reporting methodologies as it relates to regulatory compliance and reimbursement. Presents and interprets relevant financial and statistical information on behalf of the organization
Researches complex regulatory and reimbursement issues and provides analysis/summaries for management team
Provides Reimbursement staff with on-going training. Reviews Reimbursement Analyst performance while communicating and enforcing standards of performance and productivity
Two (2) years of HSCRC report preparation including but not limited to Annual Report of Revenue, Expenses and Volumes; Wage & Salary Survey; and monthly HSCRC compliance reporting
Proficient knowledge of HSCRC policies, methodologies, and reporting requirements. Experience with Medicare Cost reporting. Acute care auditing/consulting may be substituted for HSCRC report preparation
Ability to build expertise by studying HSCRC regulations and policies. Attends and participates in internal trainings and other professional educational programs as it relates to CMS and HSCRC policy
Demonstrates ability to apply knowledge of Medicare and HSCRC regulations to train, interpret, and present information to internal and external customers
Ability to judge the level of confidentiality of information / activities involved in job and exhibit integrity in use of dissemination of such information
Advanced knowledge of spreadsheets (i.e., Lotus, Microsoft Excel), databases (i.e., Microsoft Access), word processing programs (i.e., Microsoft Word), graphic/specialty and other finance-related software programs
Highly effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff

Reimbursement Analyst Resume Examples & Samples

Prepare monthly cost report accruals timely and accurately
Assist with the preparation of third party cost reports
Research and prepare schedules and provide support for third party field and desk audits, as well as financial audits
Prepare current analysis of trends and variances regarding net reimbursement rates. Maintain up-to-date reference manuals for all states in which Genesis operates
Maintain up-to-date and historical rate information from third party payors
Prepare required internal reports as directed by supervisor
Maintain analysis of prepaid and accrued insurance accounts, including workers' compensation, property, liability and health insurance
Demonstrates care and compassion to ensure that all internal and external customers consistently receive the highest quality of service
Demonstrates focus and discipline to in doing the best job possible
Exhibits honesty and integrity in all aspects of the job
Other duties, assignments and tasks as assigned by supervisor

Underpayment Reimbursement Analyst Resume Examples & Samples

Identification of under/overpayments on patient accounts and taking appropriate action to resolve the account. The position will require the ability to read and understand complex contract terms and the ability to communicate and/or resolve the deficiencies with both internal and external customers
Proactively trend and monitor information to ensure appropriate posting of contractual. Report back any negative collection trends to the Collection Manager as they occur
Participate in monthly meetings to include department and denial meetings Comply with all reimbursement and billing procedures for regulatory, third party and private insurance payers
Working Daily reports as assigned including but not limited to: Claim error report, Audit report, Payment Variance
Work closely with Collection Team to resolve account or payer issues. Identifying if underpayment or overpayment issue is related to payor, incorrect insurance iplan loaded or Billing error
Work with local Managed Care team in effort to update contract loading issues so that the correct expected reimbursement is reflected upon pricing of the claim
Minimum of three years medical billing/Collections/Business Office experience Required
Strong Collection experience a must
Prior Managed Care experience a plus
Ability to read and understand and apply managed care contracts as it relates to expected reimbursement on a facility claim
Proficiency in Computer programs such as Microsoft Excel, Word
Prior Mckesson STAR experience a plus
Strong Mathematical and Analytical Skills

Reimbursement Analyst Resume Examples & Samples

Prepares cost reports and maintains all related documentation
Analyzes regulations and calculates financial impact of changes in reimbursement
Prepares, monitors and reconciles reimbursement reports
Maintains current knowledge of regulatory changes and communicates changes as needed
Two-five years of experience in a hospital financial environment preferred

Reimbursement Analyst Intermediate Resume Examples & Samples

Act as main point of contact to Michigan Medicine affiliated hospital(s) for reimbursement advice as needed
Strong knowledge of health care finance or accounting
Senior level - (5-8) years of experience in healthcare finance and preferably experience with Medicare, Medicaid, Blue Cross and Champus cost reports and their various payment methodologies
Knowledge of governmental and other third party reimbursement methodologies

Senior Reimbursement Analyst Resume Examples & Samples

Bachelor’s degree in Business, Accounting or related discipline is required. CPA or MBA preferred
Five years progressive financial management experience in hospital or healthcare consulting environment
Clear understanding of the Maryland reimbursement system and federal reimbursement regulations
Excellent planning and organization skills
Demonstrated proficiency in the utilization of computer software programs such as Peoplesoft FMS and Microsoft office products
Proven analytical and problem solving skills with the ability to function as part of a team
Excellent oral and written communication skills and the ability to communicate complex issues in an organized format for clear understanding and analysis
Strong customer services skills and the ability to work independently with minimal supervision

Provider Reimbursement Analyst Resume Examples & Samples

May develop internal operational volume and performance reporting on the business
May develop and distribute client-facing operational volume and performance reporting
May create geographic and disruptive analyses intended to aid the sale of new business
May analyze client and prospect claim files, with development of value based savings models
May analyze internal operational processes and create incremental revenue opportunity stories based on process improvements
Commit to client service excellence
Collaborate, coordinate, and communicate across disciplines and departments
Ensure compliance with HIPAA regulations and requirements
Demonstrate Company’s Core Competencies and values held within
Minimum Bachelor’s degree in statistics, accounting, finance, economics or related field; or HS Diploma and 4 years of related experience
Minimum 2 years experience in provider compensation, fee schedules, or related area
Required licensures, professional certifications, and/or Board certifications as applicable
Knowledge of managed care contracts and principles and concepts of statistical analysis
Problem solving, analytical, organization, and communication (written, verbal and listening) skills
Ability to use software, hardware, and peripherals related to job responsibilities, including MS Office

Reimbursement Analyst Resume Examples & Samples

Inspire Through Trust, Lead By Example
Analyze contract terms, prepare fee schedules and accurately document file changes into the claims processing system (Managed Healthcare System, MHS)
Identify defects and improve accurate provider payment by performing root cause analysis on specific examples through each step of the Claims Process
Perform data analysis on large claim data samples
Provide recommendations on short and long term solutions
Monitor trends and respond quickly
Research and identify published updates to fee schedules from Medicare, Medicaid, and third party sources
Conduct testing, maintain accurate documentation and meet timelines for assigned projects
Responsible for the overall success of applicable testing, including results verification before sign-off and Production
Assist on internal and external audits of payment accuracy
Understand project concepts, objectives and approach
As the SME, represent the Claims Provider Reimbursement department on projects
Assess the current/future state of reimbursement projects and address operational impacts, workflow, and training issues of all assigned project(s)
Complete assigned tasks and/or oversee the completion of those tasks within project timelines
Demonstrate expertise in assigned reimbursement content areas
Monitor for Medicare and Medicaid changes and ensure they are reflected in all project work
Prepare Executive Summaries for management consideration
Understand Center for Medicare/Medicare Services (CMS) claims editing policies and payment methodologies
Utilize knowledge of areas related to Claims, e.g. Network, Benefits, Authorizations, Provider Operations, Finance, and Enrollment
Complete other projects and duties as assigned
High School Diploma or GED equivalent from an accredited institution
Managed care, commercial health plan (or other healthcare related) experience where you have performed cost/benefit analysis or proposed solution alternatives for contract negotiations/rate adjustments
Experience determining compensation and developing various reimbursement models using Medicaid, Medicare, and other reimbursement methodologies as a basis for recommended payments
Experience gathering and communicating complex business requirements in a simple and easy to understand manner to other staff
Experience serving on a project team as the SME (Subject Matter Expert), with proven ability to effectively communicate with all levels of the organization, including technical staff, internal non-technical staff, testing teams, and business stakeholders
Proficiency in medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract concepts and common claims processing/resolution practices
Experience with MS Excel functions that include creating standardized reports, utilizing vLookups, pivot tables, filtering and formulas to generate desired results
Bachelor’s degree or higher from an accredited institution
Experience processing facility, ancillary, Managed Long Term Care (MLTC) or physician claims
Experience using project tracking, testing and requirement tools (i.e. MS Project, SharePoint or any other time management system)
Experience with MS Access functions that include Macros and building tables for reporting purposes
Experience with facility reimbursement methodologies (i.e. Diagnostic Related Groups, DRG; Ambulatory Payment Classification, APC; or Ambulatory Patient Group, APG, etc.)
Understanding of payment and billing principles for physician or other professional services (i.e. ancillary, behavioral health, Long Term Care, etc.)
Experience working with SAS, SQL
Experience with MS Access functions that include to running queries

ESC Ops NAM Expense Reimbursement Analyst Resume Examples & Samples

Review and perform expense policy compliance on T&E reports for North America
Process “manual terminated employee/leave of absence” expense reports
Review expense reimbursement postings to back-end system and work to resolve posting issues with system support team
Support the processes of the ESC Information Center when volume dictates
Support trouble shooting and process strengthening between Call Center, Solutions and Support team and Operations team
Requires attention to detail when making judgments based on the analysis of factual information
May occasionally provide on-the-job-training to new team members
High School Diploma or 1-2 years business experience
Solid team player
Proven skills in Excel, Word, Access and Internet-based applications
Flexible and able to adapt to technological change
Dependability