Reimbursement Analyst

Company :

Job Description : 

GENERAL OVERVIEW:

Performs third-party reimbursement services, serves as a technical resource on reimbursement issues verifying third party payments. Assists in preparation of the cost reports and monthly financial closing duties. Assists with review of cost reports and budgets. Assists with oversight of Medicare and Medicaid field audits including analysis of audit adjustments and their financial impact. Assists with process improvements and special projects, working closely with the manager and senior staff.

ESSENTIAL RESPONSIBILITIES:

• Assists in preparation, evaluation, and maintenance of processes in support of regulatory and third party updates including quarterly work papers, annual audits, cost accounting, and third party cost reporting. (60%)
• 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. (15%)
• 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. (15%)
• 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. (10%)
• Performs other duties as assigned or required.

QUALIFICATIONS:

Minimum

• Bachelor’s degree in Accounting, Finance, or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 4 years in third-party reimbursement in a healthcare environment

Preferred

• Master’s degree

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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