Sr. Reimbursement Analyst

Adventist Health NW California , MD 20619

Posted 2 months ago

Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good - from the operating room to the boardroom, we are driven by our unique passion to live God's love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.

We're looking for someone to join our team as a Sr. Reimbursement Analyst who:

Develops and maintains systems for valuing Patient Accounts Receivable and Third-party settlements and explaining Net Revenue variances to budget and historical trends. Ensures that complete data is collected for the accurate and complete filing of government cost reports. Tracks and Manages adjustments by government auditors and ensures appeals are filed of any adjustments by auditors which are considered inappropriate.

Essential Functions:

  • Reviews, analyzes and interprets executed insurance contracts, government regulations and other noncontracted business reimbursement methods. Sets up and maintains a Patient Account Receivable valuation system using historical payment averages with the use of logic and judgment to effectively represent most accurate result.

  • Reviews, analyzes and interprets government regulations, applicable contract terms and cost accounting principles to set up and maintain monthly Settlement estimates which accurately calculate expected payments and contractual adjustments from all payers.

  • Analyzes revenue and contractual adjustment variances against both budget and historical trend, by both payer and business segment to inform the markets about their operational performance results on a monthly basis. Present variances to management in standardized categorizes such as volume, payer mix, service mix, acuity mix, prior period adjustments and yield.

  • Works with local markets, system shared services units and, as appropriate, with external consultants to collect and evaluate all information necessary for the accurate and complete preparation of both interim cost reports, and the filing of annual governmental cost reports.

  • Works with all appropriate internal parties to defend filed cost reports to government auditors. Tracks and manages the settlements of Prior Year cost reports and any appropriate appeals of adjustments included by the auditors in their final Notice of Program Reimbursement reports.

  • Performs other job-related duties as assigned.

You'll be successful with the following qualifications:

Education:

  • Bachelor's Degree or equivalent combination of education/related experience: Required

Work Experience:

  • Five years relevant experience: Preferred
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Sr. Reimbursement Analyst

Adventist Health NW