Senior Reimbursement Analyst

Luminis Health

Title: Senior Reimbursement Analyst

Department: Reimbursement

Reports to: Director of Revenue Strategy & Analytics

Job Code: 003138

FLSA Status: Exempt

The Senior Reimbursement Analyst is responsible for analyzing, preparing, and reviewing healthcare reimbursement data, including cost reports, volume and revenue metrics, and revenue cycle performance. This role ensures compliance with federal and state regulatory reporting requirements, leverages data analytics to optimize reimbursement strategies, and provides financial insights to support informed organizational decision-making.

1.      Prepares and reviews monthly, quarterly, and annual revenue and statistical reports for accuracy, reasonableness, completeness and distributes them to appropriate management. Including, but not limited to, monthly and quarterly HSCRC reports/reconciliations, HSCRC Annual Filing and Medicare Cost Reports.

2.      Responsible for HSCRC Case Mix data submissions and corresponding error resolution with various departments such as registration, revenue integrity, billing, and IT. This includes active participation in HSCRC data forum workgroups to ensure regulatory reporting compliance.

3.      Monitors volume and charge information to ensure unit rate and GBR compliance, making recommendations and facilitating necessary price changes.

4.      Develops/maintains analytical models to identify opportunities for reimbursement maximization to guide financial decision making across hospital operations

5.      Assists in responding to internal and external requests for information and special projects (ex: establishment of rates for new services, GBR modification requests, performance improvement initiatives, etc.)

6.      Actively participates in discussions and analysis related to quality-based reimbursement opportunities (RRIP, MHACs, QBR, etc.) and other value-based or population health reimbursement opportunities.

·         Bachelor's degree in Finance, Accounting, Statistics, Healthcare or related field from an accredited college or university.

·         Working knowledge of financial and accounting principles

·         Ability to manage multiple projects and prioritize under minimal supervision

·         Strong knowledge of computer software programs