Healthcare EDI Analyst, Sr. jobs in Sioux Falls, SD

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Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Cherapa Place Building

Location: Sioux Falls, SD

Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA

Shift: 8 Hours - Day Shifts

Job Schedule: Full time

Weekly Hours: 40.00

Salary Range: $27.50 - $44.00

Department Details

Hybrid, remote work

Job Summary

The Senior Reimbursement Analyst provides critical analytical and reimbursement related guidance and support to all operating segments across the Sanford Health enterprise. Participates in analyzing and implementing new payment methodologies in order to establish optimal reimbursement and payment levels. Recommends policies and procedures for reimbursement functions including estimating, modeling and 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/HCPS code changes.

Coordinates the impact analysis of payor proposed and final Medicare and Medicaid regulation changes. Coordinates 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). Develops reports for the annual pricing and fee schedule updates including impacts on physician compensation. Assists in the annual budgeting and audit process 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. Summarizes, presents and explains data in useful and understandable formats. Accepts and responds to questions and challenges regarding information provided. Maintains relationships with finance and accounting staff across the enterprise. Serves as a resource for individuals while providing reimbursement and accounting support. Reviews and updates policies and procedures when directed.

Qualifications

Bachelor’s Degree in Business Administration, Finance, Healthcare Management, Information Technology (IT) or related field.

Experience in health care related to claim editing, groupers, provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS) industry standard coding and payment rules. Minimum five years of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

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 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0177850

Job Function: Finance

Featured: No