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What does a Reimbursement Analyst do?

A Reimbursement Analyst plays a crucial role in healthcare finance, ensuring accurate billing and maximum reimbursement from insurance companies. They analyze claims, manage audits, and navigate complex regulations to protect the financial health of medical institutions. Curious about the skills needed for this role?
Patrick Roland
Patrick Roland

A reimbursement analyst is a financial officer who reviews and makes decisions regarding reimbursement payments for an organization. This job is found in any company that bills clients, 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 job is crucial for keeping budgets in order by keeping money that rightly belongs and dispensing any overpayment.

One of the biggest jobs for a reimbursement analyst is looking at financial documents and making judgements on health care overpayment. When an overpayment is confirmed, the reimbursement analyst job gets more complicated. Here, the analyst must determine what money has been accurately received and what money was unnecessarily charged. Based on these findings, the analyst may make recommendations about returning funds. Frequently, these issues will come to the analyst's attention based on complaints and inquiries from payment-making parties, either health care companies or individual patients.

Woman with hand on her hip
Woman with hand on her hip

Another important financial responsibility a reimbursement analyst must perform is deciding on a payment schedule. Frequently, a reimbursement can be made in a single lump sum, but many times the figure is too large. In this case, the analyst reviews budgets and available funds to estimate how the payment can be broken up. In addition, an analyst must negotiate this schedule with the party receiving the funds.

Many times a hospital's reimbursement department will determine not to return a payment. In some cases, the party asking for the money will disagree and take the hospital to court in order to obtain those funds. When this happens reimbursement analyst duties require them to go to court and represent the interests of the hospital along with the hospital's attorneys. This job frequently means testifying and providing documents proving why a particular reimbursement decision was made.

State and federal laws regarding the health care industry change frequently and a reimbursement analyst must monitor these changes. Additionally, the analyst must also be aware of internal payment policies changing independently of law. When these changes effect reimbursements the analyst revises policy documentation to accurately reflect this difference. In many cases, changes must be brought to other departments, such as legal or even a board of directors, for approval.

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