Reimbursement & Contract Analyst Job Listing at CRMC in Crosby, MN (Job ID cuyuna-11802-7837)

Description

•   The Reimbursement & Contract Analyst is responsible for the review, analysis, and management of payer contracts to ensure the organization receives accurate and timely reimbursement. This position involves tracking reimbursement trends, assisting with coordination of negotiating contracts with insurance companies, and conducting financial analysis related to payer agreements. The Analyst works closely with billing, finance, and clinical departments to optimize revenue and ensure compliance with healthcare regulations.

•   Education and Experience:  
  •    
    
    
    • Bachelor's degree in Finance, Accounting, Business Administration, Healthcare Management, or a related field.
    
    
    • A master's degree or certification in healthcare finance or contract management is preferred.
    
    
    • 3-5 years of experience in healthcare reimbursement, contract management, or related fields.
    
    
    • Experience with managed care contracting and reimbursement methodologies such as DRG, APC, and fee-for-service.
    
    
    • Experience with healthcare financial systems and revenue cycle management.
    
    
     
•   License/Certificates:  
  •   N/A
•   Special Skills and Aptitudes:  
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    • Strong analytical and financial modeling skills.
    
    
    • In-depth knowledge of healthcare reimbursement systems, payer contracts, and regulatory compliance.
    
    
    • Excellent communication skills, with the ability to present financial data to non-financial stakeholders.
    
    
    • Proficiency in Microsoft Excel and other financial software (e.g., Epic, Cerner, or similar systems).
    
    
    • Strong problem-solving abilities and attention to detail.
    
    
    • Ability to work collaboratively with cross-functional teams and manage multiple projects.
    
    
     

•    

  Contract Management:

   
  
  
  • Analyze payer contracts to ensure terms are favorable and reimbursement aligns with organizational goals.
  
  
  • Monitor payer performance and compliance with contract terms and reimbursement schedules.
  
  
  • Collaborate with the finance department to ensure contract terms are accurately reflected in the organization's billing system.
  
  
  • Assist in the negotiation and renegotiation of contracts with insurance companies and managed care organizations.
  
  
  • Maintain a database of active contracts and key terms, ensuring contracts are up to date and accessible.
  
  
   
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  Reimbursement Analysis:

   
  
  
  • Monitor and analyze reimbursement rates and patterns to ensure the organization is receiving appropriate payment for services.
  
  
  • Identify and resolve discrepancies in payments by comparing actual reimbursement to expected reimbursement based on contract terms.
  
  
  • Work with the billing and coding departments to ensure accurate claim submissions and prevent denials or underpayments.
  
  
  • Conduct variance analysis to explain differences in expected versus actual reimbursement and recommend corrective actions.
  
  
  • Prepare reports on reimbursement trends, denials, and payer compliance to inform management decisions.
  
  
   
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  Revenue Cycle Optimization:

   
  
  
  •  Collaborate with revenue cycle management teams to improve the reimbursement process and reduce the time for claims resolution.
  
  
  • Develop strategies to optimize reimbursement and minimize delays or denials in payment.
  
  
  • Analyze the financial impact of proposed or existing contracts on the organization's revenue.
  
  
  • Assist in setting up fee schedules and ensure they are aligned with contractual obligations.
  
  
   
•    

  Financial Analysis:

   
  
  
  • Conduct financial modeling and forecasting to evaluate the impact of payer contracts on the organization's revenue.
  
  
  • Prepare and present reports on reimbursement, contract performance, and financial implications to management.
  
  
  • Analyze reimbursement policies, changes in payer behavior, and new regulations to assess their impact on organizational revenue.
  
  
  • Support the development of annual budgets and forecasts related to payer contracts and reimbursement.
  
  
   
•    

  Compliance:

   
  
  
  • Ensure compliance with federal, state, and local regulations concerning payer contracts and reimbursement.
  
  
  • Monitor changes in healthcare reimbursement regulations and payer guidelines, ensuring the organization remains compliant.
  
  
  • Conduct internal audits of reimbursement and contract processes to ensure compliance and identify areas for improvement.
  
  
   
•    

  Collaboration:

   
  
  
  • Work closely with the billing, finance, and clinical teams to resolve reimbursement issues and optimize contract terms.
  
  
  • Collaborate with the legal department during contract negotiations to ensure that payer agreements align with the organization's legal and financial goals.
  
  
  • Serve as a liaison between the organization and payers to resolve contract disputes or reimbursement issues.