Reimbursement and Managed Care Analyst

Reimbursement And Managed Care Analyst

National Jewish Health is seeking a detail-oriented and analytically driven Reimbursement and Managed Care Analyst to support reimbursement strategy and managed care performance across the organization. This role plays a critical part in ensuring accurate financial reporting, optimizing payor contract performance and supporting revenue cycle operations through data analysis and contract oversight.

Key Responsibilities:

• Prepares portions of government cost reports and supports audits through detailed analysis and documentation
• Monitors managed care contracts and evaluates performance against expected reimbursement outcomes
• Analyzes reimbursement impacts, supports revenue cycle reporting and provides data-driven insights to internal stakeholders
• Assists with contract administration, including negotiations, renewals and single case agreements
• Supports charge master updates and communicates payor changes to ensure alignment across departments

National Jewish Health is the nation's leading respiratory hospital, recognized for excellence in patient care, research and education. This role directly supports the financial strength behind that mission, helping ensure sustainable funding for innovative care and life-changing research that improves outcomes for patients with complex diseases.

Position Summary The Reimbursement and Contracting Analyst contributes to the design, development and application of systems solutions to support reimbursement control and financial reporting. Assists in preparing government cost reports. Monitors managed care contracting activity to ensure reimbursement is in accordance with executed agreements.

Essential Duties

1. Prepares assigned sections of the Medicare, Medicaid and Champus/TriCare cost reports and work papers.
2. Assists with the validation and analysis of the reimbursement impact of government and managed care payor audits.
3. Provides data support and work paper documentation for various internal and external financial audits.
4. Performs various monthly statistical reports to assist in the management of the revenue cycle. Including, but not limited to accounts receivable, patient statistics and Coding department productivity.
5. Conducts ongoing studies to measure actual contract performance as compared to expected performance. Provides direction and assistance to all revenue cycle departments with respect to specific payor contract structure and expectations. Disseminates payor updates and communications to the various internal departments.
6. Implements charge description master updates and revisions, including analyzing annual CPT/ HCPCS changes that may impact the various clinical, coding and revenue cycle departments.
7. Coordinates managed care contracting including the negotiation, re-negotiation, enrollment and other administrative functions related to these agreements.
8. Negotiates single case agreements with prospective non-contracted payors and government plans.
9. Handles and assures the confidentiality of sensitive information obtained through various job responsibilities.

Other Duties

1. Assists Patient Financial Service management on special projects that require analytical assistance.
2. Assists in the preparation of the Center's net revenue budget.

Competencies

1. Accountability: Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness; confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals; demonstrates a commitment to National Jewish Health.
2. Adaptability: Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
3. Attention to Detail: Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposed standards of excellence rather than having standards imposed.
4. Business Acumen: Using economic, financial, market, and industry data to understand and improve business results; using one's understanding of major business functions, industry trends, and own organization's position to contribute to effective business strategies and tactics.
5. Collaboration/Teamwork: Cooperates with others to accomplish common goal; works with employees within and across his/her department to achieve shared goals, treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.
6. Decision Making: Identifying and understanding issues, problems, and opportunities; comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints, and probable consequences.
7. Initiative: Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.
8. Managing Work and Time: Effectively managing one's time and resources to ensure that work is completed efficiently. Effectively manages project(s) by appropriately focusing attention on the critical few priorities; effectively creates and executes against project timelines based on priorities, resource availability, and other project requirements (i.e., budget); effectively evaluates planned approaches, determines feasibility, and makes adjustments when needed.
9. Problem Solving: Uses issue identification, data relation and comparison, pattern recognition and information gathering to create analyses and make recommendations.

Supervisory or Managerial Responsibility None

Travel None

Core Values

1. Be available to work as scheduled and report to work on time.
2. Be willing to accept supervision and work well with others.
3. Be well groomed, appropriately for your role and wear ID Badge visibly.
4. Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
5. Promotes a workplace culture based on mutual respect and merit, where all individuals are treated fairly and provided with equal opportunity to contribute to the mission and goals of the institution.
6. Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures.
7. Wears appropriate PPE as outlined by the infection control policies and procedures.
8. Demonstrates compliance with all state, federal and all other regulatory agency requirements.

Minimum Qualifications

1. Education: Bachelor's degree in Business Administration, Health Care Administration or Accounting required.
2. Work Experience: A minimum of three (3) years of recent and related experience in health care reimbursement field, including Revenue Cycle and/or a minimum of one (1) year experience involving analysis of managed care contracts required.
3. Special Training, Certification or Licensure: Strong computer skills, including proficiency in Microsoft Word, Excel and Access preferred.

Salary Range: $67,454.40 - $89,208.44

Benefits At National Jewish Health, we recognize that our outstanding faculty and staff are the essence of our organization. For every aspect of health care, our employees are our greatest asset. With that in mind, we have designed a valuable, comprehensive benefits package to meet the needs of our employees and their families.

• Comprehensive Medical Coverage: Multiple Cigna health plans for Colorado, regional office and remote employees. Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) available to pair with some plans.
• Paid Time Off: Generous PTO accruals to use for vacation and sick days, and six paid holidays, all compliant with Colorado state sick leave regulations.
• Dental & Vision Plans: Coverage effective the first of the month after hire.
• Retirement Savings: 403(b) plan with employer contributions after two years.
• Wellness Incentives: Earn up to $200 annually for preventive health activities.
• Tuition Reimbursement: Up to $5,250 annually for full-time and part-time employees.
• Child Care Assistance: Childcare Flex Spending Account (FSA) with annual employer contribution.
• Loan Forgiveness: Public Service Loan Forgiveness (PSLF) eligible employer.
• Disability & Life Insurance: Employer-paid plans and optional buy-up choices.
• Voluntary Benefits: Full suite of coverage options such as Accident, Hospital Indemnity and Legal Plan
• Exclusive Discounts: Savings on local services, insurance, and RTD bus passes.