Senior Reimbursement Analyst

GENERAL OVERVIEW:

This job performs wide range of third-party reimbursement services and acts as a financial and operational liaison for operations, regulatory agencies , or other outside entities.  This incumbent serves as a technical expert on reimbursement issues for team members and management.  The incumbent analyzes financial results, trends, performance metrics and provides root cause analysis to support business decisions.  Recommends, based on trends and historical analysis, revenue adjustments or cost improvement measures.  May be responsible for management and reporting functions for programs funded by federal, state, local or commercial partners through supplemental programs or value based incentive payments.

ESSENTIAL RESPONSIBILITIES

• Leads 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 accounting.  Communicates any issues to team and management. (40%)
• Records, classifies, and summarizes financial transactions and events in accordiance with generally accepted accounting principals.  Interprets financial transactions and events for users who make economic or business decisions. (15%).
• Provides expertise and education in budgeting, revenue recognition, reimbursement, system and process changes.  Correlates Revenue/Expense to volumes and prepares reports to assess financial performance. (15%).
• Develops and/or maintains processes and performs complex calculations to support the short and long term strategic plans and operating budgets, supports monthly financial statement and comparisons of payor performance. (10%).
• Performs detailed variance analysis against expected budget, forecast, prior periods, modeling or other revenue benchmarks as required to support operations. (10%)
• Analyzes contractual or financial results, trends, performance metrics and provides root cause analysis to support business decisions.  Recommends cost saving and revenue enhancement improvement measures. (10%)
• Performs other duties and assigned or required. (0%)

QUALIFICATIONS:

Minimum

• Bachelor's Degree in Business, Finance, Accounting or related field, or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
• Proficiency with spreadsheet applications and database management
• Demonstrated ability to understand and apply complex federal regulations and policy

Preferred

• Master’s Degree in Business, Finance, Accounting or related field
• 5 -7 years of Third-party reimbursement in a healthcare environment

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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