Reimbursement Analyst III

Responsibilities

• Analyze third-party denial trends and reimbursement issues to identify root causes and recommend corrective actions.
• Lead and support appeals initiatives, collaborating with Reimbursement Administrator, including identifying appeal opportunities, tracking outcomes, and collaborating with internal and external teams to improve success rates.
• Conduct detailed analyses of data related to existing or proposed revenue cycle projects, including payor performance and denial resolution.
• Develop and present findings through graphs, charts, written summaries, and presentations for leadership review.
• Collaborate with Revenue Cycle Operations to identify areas for improvement and support the implementation of strategic projects.
• Aid in the development and documentation of Standard Operating Procedures (SOPs) for denial management and appeals processes.
• Manage the implementation of process improvements across the revenue cycle, ensuring alignment with organizational goals.
• Provide timely and accurate updates to management on outstanding denial and appeal trends using defined systems and tracking mechanisms.
• Ensure timely follow-up on unresolved issues to minimize business risks and revenue loss.
• Stay current with payor guidelines, regulatory changes, and industry best practices related to reimbursement and appeals.
• Perform other duties as assigned.

Minimum Qualifications

• Bachelor’s degree with 7 years’ Healthcare Billing Systems experience and Payor and Policy experience and advanced analytics or
• Associate degree with 9 years Healthcare Billing Systems experience and Payor and Policy experience and advanced analytics or
• HS diploma or GED with 11 years Healthcare Billing Systems experience and Payor and Policy experience and advanced analytics required

Preferred Qualifications

• 5 or more years experience with payor contracts, medical terminology, commercial and government health insurance, billing guidelines, and appeals processes.
• 3 or more years experience with SAS, Crystal Reports, Business Objects, or similar platforms.
• 5 or more years advanced Microsoft Excel (formulas, pivot tables).

Additional Job Standards

• Proven analytical and critical thinking skills.
• Excellent communication and presentation skills.
• Ability to work independently and collaboratively in a fast-paced environment.

Benefits

• Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan.

Schedule

Monday – Friday; 8:00am-5:00pm EST

Pay

$62-85K