Healthcare Reimbursement & Valuation Analyst

Job Description

Job DescriptionDescription:

Reports to: Professional Medical Solutions Director

Direct Reports: None

FLSA: Hourly, Non-Exempt

General Summary:

The Healthcare Reimbursement & Valuation Analyst is responsible for reviewing medical billing and clinical documentation, evaluating coding and billing accuracy, and performing reimbursement and valuation analyses. The role supports internal expert witnesses by analyzing healthcare payment data, applying established benchmarks, and preparing written summaries that clearly explain analytical findings. This position works primarily behind the scenes and collaborates closely with internal clinical and analytical teams.

Essential Functions

• Review clinical medical records to confirm documented services support billed charges and reported utilization.
• Evaluate coding and billing accuracy using CPT, HCPCS, and relevant billing conventions; identify discrepancies and document findings.
• Provide coding and billing review feedback to medical bill review expert witness consultants and internal stakeholders.
• Apply accepted healthcare valuation methodologies and reimbursement benchmarks to determine the reasonable value of medical services.
• Perform comparative analyses across multiple service settings, including (as applicable):
  • Hospital inpatient and outpatient
  • Ambulatory surgical centers (ASC)
  • Physician/professional services
  • Pharmacy, DME, ambulance, rehabilitation, and ancillary services
• Analyze ratios of charges to benchmarks and identify trends, outliers, and data drivers that impact valuation conclusions.
• Evaluate future medical cost estimates, including surgical cost projections and components of life care plans, using appropriate benchmark and valuation methods.
• Prepare thorough written reports that clearly explain methodology, assumptions, comparative findings, and conclusions regarding reasonable value.
• Contribute positively to a high-performing, collaborative team environment focused on quality, integrity, and continuous improvement.
• Perform additional duties, responsibilities, and special projects as assigned.

Requirements:

Required Knowledge, Skills & Abilities

• Working knowledge of healthcare payment mechanisms with the ability to research and learn new methodologies as needed.
• Ability to conduct and communicate comparative analyses in healthcare finance and reimbursement.
• Strong understanding of medical coding and billing concepts, including CPT/HCPCS, claims processing, and common billing practices.
• Familiarity with reimbursement benchmarks and payment rules, including CMS and Workers’ Compensation fee schedules and related charge indices (or demonstrated ability to learn quickly).
• Understanding of key payment contract elements and how contract structure impacts valuation and reimbursement.
• Ability to consolidate and interpret large volumes of billing, coding, and valuation data with strong attention to detail.
• Strong written communication skills—ability to produce polished reports explaining complex analyses for non-technical audiences.
• Strong analytical, critical thinking, and problem-solving abilities.
• Proficiency with Microsoft Office, especially Excel (ability to work with large datasets, formulas, and structured analysis).

Competencies

• Problem-Solving: Identifies required information, considers multiple perspectives, and applies a logical approach to determine solutions.
• Critical Thinking: Evaluates evidence, assumptions, and alternative approaches to form sound conclusions.
• Analytical Rigor: Breaks down complex data and issues into clear, defensible findings.
• Communication: Listens actively, communicates clearly, and tailors’ information to the audience.
• Customer Service Orientation: Anticipates client needs, adjusts priorities, and delivers high-quality work product.
• Organization & Time Management: Prioritizes workload, meets deadlines, and adapts to shifting demands.
• Detail Orientation: Produces accurate work and verifies supporting documentation and calculations.
• Flexibility: Embraces change, learns quickly, and remains effective in a fast-paced environment.
• Teamwork & Collaboration: Supports colleagues, shares knowledge, and contributes to team success.
• Professional Discretion: Maintains confidentiality and protects sensitive client/company information.
• Positive Attitude: Demonstrates curiosity, initiative, and a “can-do” mindset.

Education & Experience:

Entry-Level Position Requirements

• High school diploma or equivalent.
• Minimum of 2 years of medical billing and/or medical coding experience.
• Proficiency in Microsoft Office (Excel, Word, Outlook).

Professional-Level Position Requirements

• Demonstrated experience in healthcare billing operations, medical claims review, and reimbursement methodologies that support comparative analysis and valuation of medical services.

Work Environment

This job operates in a professional office environment. This is largely a sedentary role. The role routinely uses standard office equipment such as computers, data sources, phones, and photocopiers.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms. The position requires the ability to occasionally lift office products and supplies, up to ten (10) pounds.

Travel

Travel may be required for this role up to 10%.

Equal opportunity

Medical Equation is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other legally protected characteristics.

Disclaimer:

This job description does not necessarily include every responsibility, requirement, skill, or working condition associated with this role. This description is intended to reflect the role currently and management will revise the role, as needed, and may require that different tasks be performed, in order to meet the needs of the business.