Lead Reimbursement & Reporting Analyst

Company: Innova
Location: New York
Posted on: April 20, 2025

Job Description:

Innova Solutions is immediately hiring for a Lead Reimbursement & Reporting Analyst

The full job description covers all associated skills, previous experience, and any qualifications that applicants are expected to have.

Position type: Fulltime
Duration: Permanent
Location: 50 Water Street New York City, NY

Hybrid: One day pr week onsite

As a(n) Lead Reimbursement & Reporting Analyst you will:
he Lead Reimbursement & Reporting Analyst is a pivotal team member within the Reimbursement unit and will play an active role in in the company's regulatory implementation strategy. The incumbent would be responsible in ensuring regulatory requirements on fee schedules are accurately and timely implemented. The incumbent will also use SQL and quantitative analysis skills to prepare regulatory reporting, monitor progress, identify trends, and present findings with actionable recommendations. This role involves analyzing large amounts of reimbursement data,
assessing financial impact, ensuring compliance with regulations and communicating impacts to relevant internal stakeholders. The ideal candidate will have strong analytical skills, a deep understanding of healthcare reimbursement models, and experience in data reporting and analysis.

Job DescriptionResponsible for timely and accurate implementation of State mandated medical & behavioral health fee schedules.
Perform financial modeling, impact analysis, and audits on implementation.
Conduct comprehensive post claim mass adjustment (CMA) reconciliation.
Analyze large data sets to identify trends and present findings with actionable recommendations to senior leaderships and other stakeholders.
Responsible for submitting monthly/quarterly/annual reports to Finance & regulatory reporting.
Serve as subject matter expert in all areas of fee schedules, rate reimbursement, and payment methodologies.
Develop and maintain reports and provide analysis as requested by Senior Leadership in Claims to monitor claims outcomes/activity to support regulatory requirements. Identify defects in processing, overpayments, and/or underpayments.
Collaborate with departments including Compliance, Claims Operations, Core Configuration, Products,
Contracting, Provider Network Relations, and other related areas to ensure fee schedules and claims adjustments are timely and accurately loaded.
Work with a multidisciplinary team to interpret existing and develop new fee schedules and payment rates as necessary.
Collaborate with departments across the MetroPlusHealth organization to continually understand and optimize performance.

Minimum QualificationsBachelor's degree with a minimum of 7 years of relevant industry experience (business, finance, health care, consulting, insurance, government).
Health Insurance financial and data experience is necessary.
Excellent data analysis skills in SQL Server Environment are necessary.
Claims configuration experience or payment integrity experience.
Can find someone who is heavy DA with a lot of claims background or someone who is heavy claims ops with lots of data analysis and SQL
MMCOR is a PLUS
SQL is a PLUS
Proficiency in Microsoft Office (e.g., Excel, Word) is necessary.
Excellent analytical, problem-solving, and communication skills, with the ability to present complex data in an understandable manner.
Strong knowledge of healthcare reimbursement methodologies (e.g., Medicare, Medicaid, commercial payers).
Knowledge in categorization of MMCOR (Medicaid Managed Care Operating Report) is preferred.

Analytic, problem solving, technical skills and attention to detail are required.
The ideal candidate will have: 7+ years of experience
EDUCATION: Bach degree& 7 years
Associates & 9 years
HS & 11 years


Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines.
Thank you!
Elizabeth Garley
SR Technical Recruiter
Elizabeth.garley@innovasolutions.com

PAY RANGE AND BENEFITS:
Pay Range*: $90,000 per annual
*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions: One of Largest IT Consulting Staffing firms in the USA - Recognized as #4 by Staffing Industry Analysts (SIA 2022)
ClearlyRated - Client Diamond Award Winner (2020)
One of the Largest Certified MBE Companies in the NMSDC Network (2022)
Advanced Tier Services partner with AWS and Gold with MS

Website: https://www.innovasolutions.com/

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr@innovasolutions.com or (770) 493-5588. Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. - 1324b.
The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.

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