Senior Reimbursement Analyst Physician Billing

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The Senior Reimbursement Analyst – Net Revenue PB is responsible for performing complex net revenue analysis and reimbursement activities for assigned hospitals and payers. The position supports month-end close, annual budget preparation, contractual and third-party reserve analysis, journal-entry preparation, and reconciliation of net revenue data. This role serves as a subject matter expert and senior technical resource regarding net revenue methodologies, reimbursement regulations, systems, and processes. The position collaborates with reimbursement, accounting, revenue cycle, and operational stakeholders but does not have direct supervisory responsibility.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in Business Administration, Accounting or Finance.

EXPERIENCE:

1. Four (4) years of work experience in finance or accounting.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. CPA Certification.

2. Master’s degree in accounting, finance, or business administration.

EXPERIENCE:

1. Two (2) years experience performing healthcare net revenue calculations, contractual reserve analysis, reimbursement budgeting, or month-end close activities.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Provides advanced analytical and technical support for departmental net revenue reimbursement activities, including productivity, quality, process consistency, and education.

2. Serves as a senior technical resource regarding net revenue reimbursement for Reimbursement Analysts, specialty groups, committees, and other stakeholders.

3. Collaborates with reimbursement, accounting, revenue cycle, and operational stakeholders to analyze and resolve issues affecting net revenue reimbursement.

4. Serves as a subject matter expert for the Revenue Cycle Analytics application across assigned System hospitals and provides technical education, guidance, and troubleshooting support.

5. Develops and maintains an ongoing relationship with site accountants to assist with payments received or withheld relating to net revenue reimbursement.

6. Prepares annual net revenue reimbursement budget models for assigned hospitals using applicable final regulations, revenue data, statistical reports, and established methodologies. Reviews results for accuracy and explains significant assumptions or variances.

7. Applies knowledge of reimbursement components and programs, including IME, GME, DSH, RHC, bad debt, and other medical education or supplemental payment programs, when completing net revenue analyses.

8. Analyzes monthly contractual reserve estimates, identifies and explains material changes affecting accounts receivable, and prepares accurate and timely journal entries.

9. Provides peer training, technical guidance, and knowledge transfer to new and existing analysts regarding department procedures, systems, and reimbursement methodologies.

10. Supports team effectiveness by responding to technical questions, sharing subject matter expertise, contributing improvement ideas, and assisting with the resolution of complex reimbursement issues.

11. Leads or contributes subject matter expertise to process-improvement initiatives, system implementations, committee work, and cross-functional projects related to net revenue reimbursement.

12. Reconciles daily Epic accounts receivable, transaction, and charge files loaded into the Revenue Cycle Analytics application and investigates or resolves data variances between systems.

13. Reviews and updates application settings related to contractual, administrative adjustment, bad debt, and charity reserve calculations in accordance with established Enterprise Net Revenue processes and month-end deadlines.

14. Performs complex variance, trend, and root-cause analyses and presents findings and recommendations to reimbursement and finance leadership.

15. Develops, maintains, and improves analytical models, reconciliations, procedures, and internal controls to promote accuracy, consistency, and audit readiness.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit and work at a computer for extended periods of time.

2. Ability to communicate effectively through verbal, written, and electronic methods.

3. Ability to perform repetitive hand and wrist movements associated with keyboarding, data entry, and use of standard office equipment.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Work is performed primarily in a standard office or remote office environment with extensive use of computers, financial systems, video conferencing, and other electronic communication tools.

2. The employee may experience increased workload during month-end close, annual budgeting, audits, system implementations, and other designated reporting periods.

3. Occasional travel to organizational facilities, meetings, or training sessions may be required.

SKILLS & ABILITIES:

1. Advanced analytical, critical-thinking, problem-solving, and reconciliation skills.

2. Advanced proficiency in Microsoft Excel, including complex formulas, pivot tables, data validation, and analysis of large datasets.

3. Knowledge of healthcare reimbursement, net revenue methodologies, contractual allowances, third-party reserves, and accounts-receivable valuation.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

540 SYSTEM Finance and Reimbursement