Healthcare Reimbursement & Valuation Analyst

Medical Equation, Inc.•West Lake Hills, TX

1d•Onsite

About The Position

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.

Requirements

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).
High school diploma or equivalent.
Minimum of 2 years of medical billing and/or medical coding experience.
Proficiency in Microsoft Office (Excel, Word, Outlook).
Demonstrated experience in healthcare billing operations, medical claims review, and reimbursement methodologies that support comparative analysis and valuation of medical services.

Responsibilities

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.