A reimbursement analyst manages reimbursement payments for an organization, often in the healthcare industry. They analyze financial documents, decide on payment schedules, and may represent the organization in court. They must also stay up-to-date on changing laws and policies.
A reimbursement analyst is a chief financial officer who analyzes and makes decisions about reimbursement payments for an organization. This job is found in any business that bills customers, but is most commonly associated with the healthcare industry, especially hospitals. An analyst must coordinate payments to and from insurance companies, review and update hospital policies regarding reimbursement, and appear in court. This work is crucial to keeping budgets in order, keeping money that properly belongs, and distributing any overpayments.
One of the biggest jobs for a reimbursement analyst is to analyze financial documents and make judgments about excess health care payments. When an overpayment is confirmed, the reimbursement analyst’s job becomes more complicated. Here, the analyst must determine which money was accurately received and which money was unnecessarily collected. Based on these findings, the analyst can make recommendations on returning funds. Often these issues will come to the analyst’s attention based on complaints and queries from payers, both healthcare companies and individual patients.
Another important financial responsibility that a repayment analyst must perform is deciding on a payment schedule. Often, a refund can be made in a single amount, but often the number is very large. In this case, the analyst analyzes budgets and available funds to estimate how the payment can be divided. In addition, an analyst must negotiate this schedule with the party receiving the funds.
Often, a hospital’s reimbursement department will decide not to return a payment. In some cases, the party requesting the money disagrees and takes the hospital to court to obtain those funds. When this happens, the claims analysts’ duties require them to be brought into court and represent the hospital’s interests, along with the hospital’s attorneys. This work often means testifying and providing documents that support why a particular reimbursement decision was made.
State and federal laws pertaining to the healthcare industry change frequently, and a reimbursement analyst must monitor these changes. In addition, the analyst must also be aware of internal payment policies that change regardless of the law. When these changes effect refunds, the analyst revises the policy documentation to accurately reflect this difference. In many cases, changes must be taken to other departments, such as the legal department or even a board of directors, for approval.
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