Reimbursement Analyst - Health Plan Administration
Sanford Health - Sioux Falls, SD

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The Reimbursement Analyst position will support the Sanford Health Plan.

The Sanford Health Plan is a growing company with 120+ employees spanning a 4 state-region providing fully insured and self funded healthcare benefits to over 66,000 members.

The Reimbursement Analyst is responsible for providing critical analytical and negotiation support with respect to the Health Plan's provider reimbursement methodologies. Work includes analyzing reimbursement methodologies to establish optimal reimbursement levels. Also audits payment configuration to ensure financial accuracy of claims adjudication according to contract. In providing these services, employee will be accountable to the Health Plan's Association Actuary and provides decision support to the Provider Relations Department to address critical provider reimbursement issues, new reimbursement methodologies and payment rules.

Experience with decision-support and financial and/or coding background preferred.

Required Skills

Bachelors Degree in Business Administration, Finance, Health Care Management, IT or related field; or equivalent business experience. Experience in health care related to claim editing, groupers, provider reimbursement and methodologies (MS-DRG; APC) industry standard coding and payment rules. 2-5 years of related work experience, preferably in hospital or insurance finance and/or managed care reimbursement.

Required Experience

Sanford Health - 18 months ago - save job - copy to clipboard - block