Senior Reimbursement Analyst

The Senior Reimbursement Analyst role reports to the Senior Director of Finance and is instrumental in identifying billing and payor reimbursement opportunities and enhancing the hospital's overall reimbursement. This person will review, analyze, and prepare margin and payment accuracy reports to ensure the accuracy and completeness of our Accounts Receivable and Operating Revenues. Their expertise can lead to more accurate claims submissions, reduced denial rates, and improved cash flow in compliance with relevant accounting processes and regulations. This role is pivotal in securing the financial health of the hospital, enabling it to continue providing high-quality care to its growing patient population while adapting to the dynamic healthcare reimbursement landscape.

Duties

• Work daily within the Hospital’s Electronic Medical Records to review claims, denials, and payments records to identify reimbursement opportunities.
• Communicate and work directly with Patient Accounting team to evaluate and recommend collections work priorities, including payment variances to contract for follow up.
• Call third-party payors to understand aged, stuck Accounts Receivable errors and work with Patient Finance and Hospital Leadership to resolve billing and collections errors timely
• Maintain payor contracts files and expected reimbursement by service line and contract, alerting leadership of risks and opportunities. Support the VP finance in payor negotiations, analysis and deadlines
• Generate financial reports, reimbursement reports, and management reports on a periodic basis that summarize our key performance metrics as it relates to billing and accounts receivable.
• Gather information for internal and external auditors and prepare government reports / cost report data for regulatory filings, following all appropriate guidelines.
• Review monthly, quarterly, and annual financial statements – and help prepare slide decks for executive leadership.
• Maintain accounting controls by recommending policies and procedures for billing, contracting, and payment records.

Qualifications

• Bachelor’s degree in finance or accounting related field
• Three to five years of work experience with specific experience in finance and / or billing and accounts receivable
• Extensive experience in medical billing and coding within a medical office setting.
• Proficiency in medical terminology and familiarity with coding systems such as ICD-9, ICD-10, and DRG.
• Experience with EPIC Medical Record System.
• Strong analytical skills with the ability to interpret complex data related to reimbursement processes.
• Excellent communication skills for effective collaboration with healthcare professionals and insurance representatives.
• Detail-oriented mindset with a commitment to accuracy in all aspects of work.
• Knowledge of electronic health record (EHR) systems is preferred but not mandatory.

Franciscan Children’s requires all employees to be vaccinated against COVID-19 and Flu, (unless you are eligible for a medical or religious exemption).