Reimbursement Analyst

Remote Jobs; Sioux Falls (SD); Remote; USD 33.000 - 53.000; Vollzeit

Zusammenfassung

Sanford Health is seeking a Reimbursement Analyst to provide analytical and reimbursement support across operating segments. The role involves analyzing and implementing payment methodologies to optimize reimbursement, and supporting Medicare, Medicaid, and other third-party programs with audits, cost reports, and contract changes.

The position offers remote work flexibility with exposure to senior leadership, cross-functional teams, and opportunities to shape payment models that improve

Qualifikationen

• Bachelor degree required in business administration, finance, healthcare management, information technology (IT) or related field.
• Minimum two years of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement.
• Demonstrated knowledge and experience in health care reimbursement related to claim editing, groupers, provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS) industry standard coding and payment rules.
• Minimum one year of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement.

Aufgaben

• Assists in analyzing and implementing new payment methodologies in order to establish optimal reimbursement and payment levels.
• Participates in the implementations and monitoring of reimbursement functions, which includes Medicare, Medicaid or other third party cost reports, related audits, appeals, disproportionate share hospital (DSH) programs, drug discount programs (340B) and CPT/HCPCS code changes.
• Prepares the impact analysis of payor proposed and final Medicare and Medicaid regulation changes.
• Assists with the impact analysis of payor contract changes during negotiations and finalizations of contracts.
• Prepares third party payor contracts in Experian and Contract Maintenance (i.e. hospital and clinic payment integrity tools).
• Researches third party payor issues.
• Supports the annual pricing and fee schedule updates, including impacts on physician compensation.
• Assists in the annual budgeting and audit processes such as monthly discounts, year-end discounts and third party reserves.
• Provides on-going support of operations and CDM team in maintaining chargemasters, particularly as it relates to setting up new codes and establishing prices.
• Assists in on-going pricing initiatives across the enterprise.
• Produces reports, analyzes and integrates data alongside completing other projects accurately and efficiently.
• Possesses strong attention to detail.
• Promotes integrity and confidentiality of data when sharing with others.
• Prepares data in a useful and understandable format.
• Accepts and responds to questions and challenges regarding information provided.
• Supports relationships with finance and accounting staff across the enterprise.

Ausbildung

Bachelor degree in business administration, finance, healthcare management, information technology (IT) or related field

Jobbeschreibung

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

40

Compensation:

Salary Range: $24.00 - $38.50

Union Position:

No

Department Details

This position offers a unique opportunity to lead and contribute to strategic Provider Network Economics initiatives that directly influence reimbursement strategy, provider partnerships, operational performance, and organizational financial results. The role provides significant exposure to senior leadership, extensive cross-functional collaboration, and the opportunity to shape innovative payment models that support high-quality, affordable healthcare. Beyond the strategic impact of the work, you will join a high-performing and highly collaborative team that values initiative, intellectual curiosity, and a growth mindset. We seek individuals who are energized by solving complex problems, building strong partnerships, challenging conventional thinking, and identifying opportunities to improve processes and outcomes. Candidates who thrive in an environment that emphasizes teamwork, accountability, continuous learning, and innovation will find this role both challenging and rewarding. This position also offers the flexibility of working remotely, enabling team members to collaborate effectively while maintaining a healthy work-life balance.

Summary

The Reimbursement Analyst provides analytical and reimbursement related support to operating segments across the Sanford Enterprise, working with all operating segments.

Job Description

Assists in analyzing and implementing new payment methodologies in order to establish optimal reimbursement and payment levels. Participates in the implementations and monitoring of reimbursement functions, which includes Medicare, Medicaid or other third party cost reports, related audits, appeals, disproportionate share hospital (DSH) programs, drug discount programs (340B) and CPT/HCPCS code changes. Prepares the impact analysis of payor proposed and final Medicare and Medicaid regulation changes. Assists with the impact analysis of payor contract changes during negotiations and finalizations of contracts. Prepares third party payor contracts in Experian and Contract Maintenance (i.e. hospital and clinic payment integrity tools). Researches third party payor issues. Supports the annual pricing and fee schedule updates, including impacts on physician compensation. Assists in the annual budgeting and audit processes such as monthly discounts, year-end discounts and third party reserves. Provides on-going support of operations and CDM team in maintaining chargemasters, particularly as it relates to setting up new codes and establishing prices. Assists in on-going pricing initiatives across the enterprise. Produces reports, analyzes and integrates data alongside completing other projects accurately and efficiently. Possesses strong attention to detail. Promotes integrity and confidentiality of data when sharing with others. Prepares data in a useful and understandable format. Accepts and responds to questions and challenges regarding information provided. Supports relationships with finance and accounting staff across the enterprise. Serves as a resource for individuals while providing reimbursement and accounting support. Reviews and assists in revising policies and procedures when directed.

Qualifications

Bachelor degree required in business administration, finance, healthcare management, information technology (IT) or related field. Minimum two years of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement. Demonstrated knowledge and experience in health care reimbursement related to claim editing, groupers, provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS) industry standard coding and payment rules. Minimum one year of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to [e-mail].