Job Description

Adventist Health Roseville is looking for Sr. Reimbursement Analyst. We are looking for great individual who can work onsite to our location in Roseville, CA

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Develops and maintains systems for valuing Patient Accounts Receivable and Third-party settlements and explaining Net Revenue variances to budget and historical trends. Ensures that complete data is collected for the accurate and complete filing of government cost reports. Tracks and Manages adjustments by government auditors and ensures appeals are filed of any adjustments by auditors which are considered inappropriate.

Job Requirements:

Education and Work Experience:

• Bachelor's Degree or equivalent combination of education/related experience: Required
• Five years' relevant experience: Preferred

Essential Functions:

• Reviews, analyzes and interprets executed insurance contracts, government regulations and other noncontracted business reimbursement methods. Sets up and maintains a Patient Account Receivable valuation system using historical payment averages with the use of logic and judgment to effectively represent most accurate result.
• Reviews, analyzes and interprets government regulations, applicable contract terms and cost accounting principles to set up and maintain monthly Settlement estimates which accurately calculate expected payments and contractual adjustments from all payers.
• Analyzes revenue and contractual adjustment variances against both budget and historical trend, by both payer and business segment to inform the markets about their operational performance results on a monthly basis. Present variances to management in standardized categorizes such as volume, payer mix, service mix, acuity mix, prior period adjustments and yield.
• Works with local markets, system shared services units and, as appropriate, with external consultants to collect and evaluate all information necessary for the accurate and complete preparation of both interim cost reports, and the filing of annual governmental cost reports.
• Works with all appropriate internal parties to defend filed cost reports to government auditors. Tracks and manages the settlements of Prior Year cost reports and any appropriate appeals of adjustments included by the auditors in their final Notice of Program Reimbursement reports.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.