Lead Reimbursement and Reporting Analyst / Hybrid / NYC
Full-Time | Hybrid (2 Days Onsite in Manhattan, 3 Days Remote)
Salary: $80,000–$90,000 + Excellent Benefits, Including a Pension Plan

Join a mission-driven health plan that has been delivering high-quality care to New Yorkers for over 30 years. With a strong commitment to member and provider relationships, this organization serves communities across all five boroughs through a comprehensive range of health products.

The Lead Reimbursement and Reporting Analyst is a key member of the Reimbursement team, responsible for supporting regulatory implementation efforts and ensuring the accurate and timely application of mandated fee schedules. This role involves deep data analysis, regulatory reporting, and cross-functional collaboration.
Lead Reimbursement and Reporting Analyst Key Responsibilities:

• Implement state-mandated medical and behavioral health fee schedules.
• Conduct financial modeling, impact assessments, and audits on reimbursement implementations.
• Lead post-claim mass adjustment (CMA) reconciliations.
• Analyze large data sets to monitor trends and provide strategic recommendations.
• Prepare and submit monthly, quarterly, and annual reports to Finance and Regulatory bodies.
• Act as a subject matter expert on fee schedules, reimbursement rates, and payment methodologies.
• Develop reporting tools and dashboards to monitor claims outcomes and regulatory compliance.
• Identify and resolve processing issues, overpayments, and underpayments.
• Collaborate with teams including Compliance, Claims, Core Configuration, Contracting, and Provider Relations to ensure fee accuracy and timely adjustments.
• Partner with internal stakeholders to develop new reimbursement models and optimize performance.

Lead Reimbursement and Reporting Analyst Qualifications:

•  Bachelor’s degree with at least 7 years of experience in healthcare, finance, insurance, or a related field OR Associate’s degree with at least 9 years of experience in healthcare, finance, insurance, or a related field High School diploma with at least 11 years of experience in healthcare, finance, insurance, or a related field 
• Strong data analysis experience within a health insurance environment.
• Proficient in SQL Server and Microsoft Office (especially Excel).
• Strong understanding of Medicare, Medicaid, and commercial payer reimbursement methodologies.
• Familiarity with MMCOR (Medicaid Managed Care Operating Report) reporting preferred.
• Proven analytical and problem-solving abilities with excellent attention to detail.
• Clear and effective communication skills, with the ability to present data-driven insights to leadership.

Lead Reimbursement and Reporting Analyst Salary: Salary up to $90,000 with excellent benefits (pension plan)

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