A reimbursement analyst is a financial officer who reviews and makes decisions for an organization’s reimbursement payments. This position can be found in any business that bills customers, but it is most commonly associated with the healthcare industry, particularly hospitals. An analyst’s responsibilities include coordinating payments to and from insurance companies, reviewing and updating hospital reimbursement policies, and appearing in court. This position is critical for keeping budgets in order by retaining money that belongs to it and disbursing any overpayments.
Examining financial documents and making decisions on health-care overpayment is one of the most important tasks for a reimbursement analyst. The reimbursement analyst’s job becomes more difficult when an overpayment is confirmed. Here, the analyst must determine what money was received correctly and what money was charged unnecessarily. The analyst may make recommendations about how to return funds based on these findings. Complaints and inquiries from payment-making parties, such as health-care companies or individual patients, frequently bring these issues to the analyst’s attention.
A reimbursement analyst must also decide on a payment schedule, which is an important financial responsibility. A reimbursement can often be made in one lump sum, but the amount is frequently too large. The analyst in this case examines budgets and available funds to determine how the payment can be divided. Furthermore, an analyst must work out a schedule with the party who will be receiving the funds.
Many times, the reimbursement department of a hospital will decide not to return a payment. In some cases, the party seeking the funds will disagree and file a lawsuit against the hospital in order to obtain the funds. When this occurs, reimbursement analysts must go to court and represent the hospital’s interests alongside the hospital’s attorneys. This job frequently entails giving testimony and submitting documents to support a reimbursement decision.
The health-care industry’s state and federal laws change frequently, and a reimbursement analyst must keep track of these changes. In addition, the analyst must be aware of any changes in internal payment policies that are not governed by the law. When these changes have an impact on reimbursements, the analyst updates the policy documentation to reflect the change. In many cases, changes must be submitted to other departments for approval, such as legal or even the board of directors.