Senior Reimbursement Analyst

Employment Type:

Shift:

Description:

Purpose

Work Remote Position

Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing of department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications.

• Analyzes tentative and final settlements. Coordinates, researches and analyzes prior year reopening and appeals.
• Prepares financial month end close reporting for Net Revenue. Responsibilities include, but are not limited to, accessing databases, and utilizing reporting tools to extract data, generate reports, perform data analysis, and draft system/process improvement recommendations.
• Prepares analyses and interprets highly complex reimbursement issues. Prepares complex financial models and analyses to assure proper reimbursement.
• Participates in third-party payer preparing impact analysis and recommendations.
• Reviews and analyzes member organization third party reserves and net revenue/contractual calculations.
• Prepares project analysis regarding operational issues, new programs, service lines, expansions, etc.

Note: “patients” refers to patients, clients, residents, participants, customers, members

Essential Functions

Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.

Work Focus:

• Researches, collects & analyzes information.
• Identifies opportunities, develops solutions, & leads through resolution.
• Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience.
• Responsible for distribution of analytical reports.

Process Focus:

• Utilizes multiple system applications to perform analysis, create reports & develop educational materials.
• Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized.
• Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.

Data Management & Analysis:

• Research & compiles information to support ad-hoc operational projects & initiatives.
• Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making.
• Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.

Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.

Functional Role (not inclusive of titles or advancement career progression)

• Conducts prospective analysis of the potential financial impact on the member organizations of major changes in Medicare and Medicaid policies.
• Assists in related advocacy efforts regarding such regulatory changes.
• Prepares Medicare and Blue Cross home office cost reports for the Trinity Health Corporate Office and Trinity Information Systems.
• Participates in the Medicare and Blue Cross audits of Trinity Health Corporate Office, Trinity Information Systems, and the various insurance programs.
• Participates in third party payer contract negotiations, preparing impact analysis and recommendations.
• Provides analytical reimbursement support, consulting, and education to the corporate office and member organizations.

(Salary Range: $36.3426-$54.5140)

Minimum Qualifications

• Education: Bachelor’s degree in business administration, accounting, finance, informatics or related field, or an equivalent combination of education and related experience.
• 5 plus years of experience in progressively responsible operational or consulting for revenue management (e.g., reimbursement, cost reporting, forecasting, decisions support, health information management).

Additional Qualifications (nice to have)

• None

Physical & Mental Requirements & Working Conditions (General Summary)

Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
• Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
• Exposure to interruptions, shifting priorities & stressful situations. Frequent
• Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent
• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent
• Perform manual dexterity activities & / or grasping / handling. Frequent
• Ability to climb, kneel, crouch & / or operate foot controls. Occasional
• Use a computer / other technology. Frequent
• Sit with the ability to vary / adjust physical position or activity. Frequent
• Maintain a safe working environment & use available personal protective equipment (PPE). Continuous
• Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines. Continuous
• Ability to provide assistance in the event of an emergency. Occasional

Direct Healthcare Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Frequent
• Lift a maximum of 30 pounds unassisted. Occasional
• Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Continuous
• Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional

Indirect Healthcare / Support Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Frequent
• Lift a maximum of 30 pounds unassisted. Occasional
• Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
• Encounter a clinical / patient facing / hands on interactive work environment. Occasional
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Work outdoors with variable external environmental conditions. Occasional

Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.