Sanford Health Senior Reimbursement Analyst - Strategic Reimbursement in Sioux Falls, South Dakota

Job Title: Senior Reimbursement Analyst | Strategic Reimbursement | Multi-City

City: Fargo

State: Multi-State


Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr


Responsible for providing critical analytical and reimbursement related guidance and support to operating segments across the Sanford Enterprise. This position will be working with all operating segments of the Enterprise. The Senior Analyst will be a strategic lead in analyzing and implementing new payment methodologies to establish optimal reimbursement and payment levels. The position will recommend policies and procedures for reimbursement functions including estimating, modeling and reporting provider reimbursement/payment levels.


Manage the implementation and monitoring of reimbursement functions which includes Medicare, Medicaid or other third party cost report, related audits, appeals, disproportionate share hospital (DSH), drug discount program (340B) CPT/HCPCS codes changes.Coordinate the review and impact analysis of proposed and final Medicare and Medicaid regulation change.Coordinate the impact analysis of payor contract changes during negotiations and finalizations of contracts.Develop third party payor contracts in Experian and Contract Maintenance (i.e. hospital and clinic payment integrity tools).Be a resource for third party payor issues. Develop reports for the annual pricing and fee schedule updates including impacts on physician compensation. Assist in the annual budgeting and audit process; monthly and year-end discounts and third party reserves.Coordinate on-going support of operations and CDM team in maintaining chargemasters particularly as it relates to setting up new codes and establishing pricing.Assist in on-going pricing initiatives across the Enterprise.Produce reports, analyzes and integrates data and completes other projects accurately and efficiently. Pays close attention to detail. Promotes integrity and confidentiality of data when sharing with others. Summarizes, presents and explains data in useful and understandable format. Accepts and responds to questions and challenges to the information provided. Develop and maintain relationships with finance and accounting staff across the Enterprise.Be a resource for those individuals and provide reimbursement and accounting support.Demonstrates the ability to be a self-starter. Has strong organizational skills when managing projects. Uses critical thinking to query appropriate data for project development.Consistently demonstrates ability to obtain and integrate information from several sources.Review and update policies and procedures when appropriate.



Bachelor's Degree in Business Administration, Finance, Health Care Management, IT or related field. Experience in health care related to claim editing, groupers, provider reimbursement and methodologies (MS/APR DRG; APC, EAPG, CPT/HCPCS) industry standard coding and payment rules. Has knowledge and is able to use of PC based applications such as Excel, Access, business objects, 3M tools, etc. Five or more years of related work experience, preferably in hospital, clinic or insurance finance and/or managed care reimbursement.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing. Every day, we show that commitment by delivering the highest quality of care to the communities we serve. We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases. We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to .

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employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at or here for Spanish Version at .

City: Multi-City

State: Multi-State

Job Function: Financial Services

Job Schedule: Full Time

Shift: Days

Req Number: req19864