Reimbursement Analyst; Remote

Position: Reimbursement Analyst (Remote)

Join to apply for the Reimbursement Analyst (Remote) role at Care First Blue Cross Blue Shield
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Job Overview

This position may be responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and workflows for healthcare providers’ reimbursement fee levels. The incumbent will work with various commercial and government program related fee schedules, develop recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks. They will review and analyze information for various provider reimbursement and network strategy projects, preparing routine reports and fee disclosure related documents.

Knowledge of Medicare or Medicare Advantage products is preferred.

Essential Functions

• Work with claims data retrieved from a variety of sources via Excel and Access tools. Perform competitive financial analyses of the data, providing various scenarios and recommendations using negotiation strategies by various departments. Utilizing commercial and government program fee schedule benchmarks.
• Work with Care First Commercial and Government Program fee schedules, participate in periodic review, provide scenarios for reimbursement models and alternatives. Make recommendations to management. Assist in developing pricing recommendations for services across the different fee schedules.
• Respond to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching Medicare, Medicaid and other industry policies and reimbursement methodologies. Compile fee schedule disclosure files upon requests and pricing of daily claim inquiries from various internal platforms.

Qualifications

Education Level: Bachelor’s Degree in Health Care Administration, Business Administration, Finance or related field OR in lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years doing financial analysis/modeling in the field of health insurance or health care.

Preferred Qualifications

Understanding of national or local reimbursement mechanisms and methodologies.

Knowledge, Skills & Abilities

• Knowledge of Medicare and Medicare Advantage products and offering across the market.
• Excellent verbal and written communication skills.
• Excellent PC skills including intermediate to advanced level knowledge of Microsoft Access and advanced level knowledge of Microsoft Excel, and Microsoft Word.
• Analytical and mathematical aptitude and have the ability to manage multiple tasks at the same time while prioritizing projects in order to accomplish departmental and corporate goals and objectives.
• The ability to develop financial models/impact analyses and recommend action to management based on the results of those models.

Salary Range

$53,424 - $106,106

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as scope and responsibilities of the position, candidate's work experience, education/training, internal peer equity, and market and business considerations. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances including but not limited to experience, internal equity, and location.

In addition to your compensation, Care First offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Provider Payment and Regulator

Equal Employment Opportunity

Care First Blue Cross Blue Shield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where to Apply

Please visit our website to apply:

Federal Disclosure/Physical Demand

Note:

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Eligibility

Must be eligible to work in the U.S. without Sponsorship.

Seniority Level

Mid‑Senior level

Employment Type

Full‑time

Job Function

Finance and Sales

Industries

• IT Services and IT Consulting
• Financial Services
• Hospitals and Health Care

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