Job Role Description

Insurance > Reimbursement Analyst

Salary National Average

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Short Description:

A Reimbursement Analyst is responsible for reviewing and analyzing healthcare claims, payments, and financial data to ensure accurate reimbursement from insurance providers and government programs. They identify discrepancies, resolve payment issues, and collaborate with billing, coding, and clinical teams to optimize revenue. The role involves preparing reports, maintaining documentation, and ensuring compliance with regulatory and organizational policies. Reimbursement Analysts help maximize revenue cycle efficiency and support accurate financial reporting. Strong analytical, problem-solving, and communication skills are essential for success in this role.

Duties / Responsibilities:

  • Review and analyze claims, payments, and billing data to ensure accurate reimbursement from insurance providers
  • Evaluate payer contracts, fee schedules, and reimbursement policies to identify discrepancies or opportunities for optimization
  • Collaborate with billing, coding, and revenue cycle teams to resolve claim denials, underpayments, or overpayments
  • Prepare detailed reports on reimbursement trends, payment variances, and financial performance for management
  • Maintain accurate records of reimbursement activities, adjustments, and communications with payers
  • Research and interpret regulatory guidelines, payer policies, and industry standards impacting reimbursement
  • Identify and implement process improvements to streamline reimbursement workflows and increase revenue capture
  • Provide support for audits, financial reviews, and compliance initiatives related to reimbursement processes
  • Communicate effectively with internal teams, external payers, and providers regarding reimbursement issues
  • Stay up-to-date on changes in healthcare regulations, payer policies, and reimbursement methodologies

Skills / Requirements / Qualifications

  • Education: Bachelor’s degree in Healthcare Administration, Finance, Accounting, or related field preferred
  • Experience: 2–5 years of experience in medical billing, revenue cycle, or reimbursement analysis
  • Technical Knowledge: Proficiency in electronic health records (EHR), billing software, and data analysis tools
  • Analytical Skills: Ability to review complex financial data, identify trends, and resolve discrepancies
  • Attention to Detail: Accuracy in claim review, payment analysis, and documentation
  • Problem-Solving: Ability to investigate reimbursement issues and implement corrective solutions
  • Communication: Strong verbal and written skills for interacting with payers, providers, and internal teams
  • Regulatory Knowledge: Understanding of healthcare regulations, payer policies, and reimbursement standards

Job Zones

  • Title: Job Zone Four: Considerable Preparation Needed
  • Education: Most of these occupations require a four-year bachelor's degree, but some do not. 
  • Related Experience: A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. 
  • Job Training: Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.
  • Job Zone Examples: Many of these occupations involve coordinating, supervising, managing, or training others. 
  • Specific Vocational Preparation in years: 2-4 years preparation (7.0 to < 8.0)

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