Senior Reimbursement Analyst

Trinity Health Mid-Atlantic; Des Moines (IA); On-site; USD 85,000 - 115,000; Full time

Job summary

Trinity Health seeks a Senior Reimbursement Analyst to join the MercyOne family and lead reimbursement activities aligned with the organization's mission, vision and values. The role involves data extraction, reporting, and financial modeling to support Medicare and Medicaid programs.

Responsibilities include preparing cost reports, forecasts, audits, and analyses, while ensuring compliance with federal and state regulations and collaborating with corporate offices on reimbursement strategies.

Qualifications

• Bachelor’s degree in Business Administration, Finance, Accounting, Informatics or related field or equivalent experience.
• 5–7 years of revenue management or reimbursement experience in healthcare.
• Advanced proficiency with Microsoft Office, financial systems, databases and BI tools.
• Strong analytical, quantitative and problem-solving skills.

Responsibilities

• Accessing databases and reporting tools to extract data, generate reports, and draft improvement recommendations.
• Prepare Medicare, Medicaid, Blue Cross and Tricare cost reporting and rolling forecasts.
• Monitor reimbursement regulations and ensure compliance across programs.
• Develop financial models and analyses to assure proper reimbursement.
• Support and educate the corporate office and member organizations on reimbursement issues.
• Coordinate with third-party payers on impact analysis and appeals.

Skills

Analytical thinking

Quantitative analysis

Problem solving

Communication

Leadership

Education

Bachelor’s degree in Business Administration, Finance, Accounting, Informatics or related field

Tools

MS Excel

MS Word

PowerPoint

BI reporting tools

Relational databases

Job description

Employment Type: Full time Shift: Day Shift

Description: Join the MercyOne Family as a Senior Reimbursement Analyst. As a Senior Reimbursement Analyst you know, understand, incorporate and demonstrate the mission, vision and values of Trinity Health in leadership behaviors, practices and decisions.

Responsibilities

• Accessing databases, and utilizing reporting tools to extract data, generate reports, perform data analysis, and draft system/process improvement recommendations.
• Must have accounting experience
• Conduct prospective analysis of the potential financial impact on the member organizations of major changes in Medicare and Medicaid policies.
• Assist in related advocacy efforts regarding such regulatory changes.
• Monitors policies and procedures to ensure reimbursement practices adhere to federal, state and other third-party reimbursement regulations.
• Prepares Annual Medicare, Medicaid, Blue Cross and Tricare cost reporting for the Trinity Health Corporate Office and Trinity Information Systems.
• Prepares quarterly Medicaid reporting schedules.
• Prepares Rolling Forecasts and Annual Budgets.
• Participates in the Medicare, Medicaid and Blue Cross audits of Trinity Health Corporate Office, Trinity Information Systems, and the various insurance programs with focus on Graduate Medical Education, Disproportionate Share, Bad Debt and the S-10.
• Analyzes tentative and final settlements.
• Coordinates, researches and analyzes prior year reopening and appeals.
• Prepares financial month end close reporting for Net Revenue.
• Prepares analyses and interprets highly complex reimbursement issues.
• Prepares complex financial models and analyses to assure proper reimbursement.
• Participates in third-party payer preparing impact analysis and recommendations.
• Participates in developing and monitoring appeals with third party payers.
• Provides analytical reimbursement support, consulting, and education to the corporate office and member organizations.
• Reviews and analyzes member organization third party reserves and net revenue/contractual calculations.
• Conducts analysis related to revenue improvement initiatives.
• Prepares project analysis regarding operational issues, new programs, service lines, expansions, etc.
• Serves as a subject matter expert and resource by providing guidance and problem resolution to internal associates on matters impacting projects and day-to-day assignments.
• Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
• Performs other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in Business Administration, Finance, Accounting, Informatics or related field or an equivalent combination of education and related experience.
• Five (5) to seven (7) years of progressively responsible operational or consulting experience in revenue management (e.g., reimbursement, cost reporting, forecasting, decision support, health information management).
• Some knowledge and experience of the healthcare industry or hospital financial operations.
• Advanced proficiency with Microsoft product suite (MS Word, Excel, Power Point), financial systems/software, relational database management and business intelligence reporting tools.
• Ability to utilize PC-based financial tools (i.e., spreadsheets, databases, graphics, etc.).
• Must possess a high degree of analytical, quantitative, evaluative and problem-solving skills.
• Considerable knowledge and experience supporting and developing reporting and analytics for research, process improvement support and specific revenue management function.
• Ability to develop appropriate methods to collect, analyze and report data.
• Must possess a personal presence that is characterized by a sense of honesty, Integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings.

By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states.

Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services.

Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs.

For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.