Provider Reimbursement Analyst
Blue Cross Blue Shield Kansas

Job Info

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Blue Cross and Blue Shield of Kansas is looking to add to our Medical Economics team and has an opportunity for a Provider Reimbursement Analyst. This position is responsible for designing, extracting, and analyzing large datasets from both internal and external sources while working closely with the Provider Analysis team. The information will be used to identify opportunities to reduce healthcare cost and utilization through provider reimbursement initiatives, such as Fee for Services Maximum Allowable Payments, and the Quality Based Reimbursement Programs (QBRP). Creates, maintains, and validates datasets to analyze current provider payouts, recommends future payment structures, and develops new payment networks as needed.

"This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

Compensation

$80,720 - $96,000
Exempt Grade 16

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you'll do

• Assist with management of reimbursement activities related to proper MAP levels for services provided by providers or facilities. This involves developing technical studies, analyses and fiscal impacts that serve as a focal point in the presentation of pricing and methodologies of institutional and professional provider payment programs.
• Collaborate with cross-functional teams to integrate provider reimbursement strategies with broader financial and operational goals.
• Develops comprehensive studies that guide the presentation and implementation of new pricing and reimbursement methodologies.
• Work directly with providers and their representatives when needed in the study model review.
• Designs and prepares financial exhibits that detail "cost of MAP increases".
• Assists and conducts provider contract reimbursement and policy audits internal and external sources.
• Ability to develop queries that will be used to extract claim data to be researched for payment accuracy and perform claims recovery activities.
• Responsible for the development of reimbursement pricing file updates, provider payment record files, and payment listings shared with providers.

What you need

• Bachelor's degree in finance, Accounting, Mathematics, Statistics, Risk Management, Economics, Health Care or related degree.
• In lieu of degree, 8 years managed care billing or pricing / financial analysis experience is required.
• At least three years' experience with technology administration, health care reimbursement, managed care billing and pricing, applied mathematics, financial economics, or another relevant field.
• Experience in health economics and other fields of health care including present problems and future trends.
• Experience with and an understanding of data warehouse structures, data extraction tools, analytics software and methods, and data modeling.
• Ability to identify and make sense of rich data sources, manage large amounts of data, merge datasets, ensure consistency of datasets, graphically portray data to gain insights, build statistical models, understand data, and model shortcomings, and effectively communicate findings.
• Requires advanced analytical, problem solving, and strategic thinking skills.
• Proficient in SQL with the capability to learn additional programming languages as needed.
• Proven experience in quantifying, measuring, and analyzing financial and utilization metrics within healthcare settings.
• Demonstrate experience in quantifying, measuring, and analyzing financial and utilization metrics of healthcare. A broad general knowledge of medical terminology, professional protocol, medical economics, and business practices and procedures of professional providers. This includes extensive knowledge of procedural and diagnosis coding in both the physician office and hospital outpatient setting.
• Must have excellent written and oral communication skills, with the ability to convince and defend the reasonability of research analyses, findings, and process designs to a wide array of both technical and non-technical persons.
• Ability to make decisions using independent judgment and creativity to resolve issues and overcome roadblocks.
• Must be proficient at advancing multiple projects simultaneously and prioritizing activities based on immediate business needs.

Bonus if you have

• Experience with and knowledge of the healthcare deliver system and the health insurance industry is preferred.
• Preferred experience with Microsoft Word, Excel, QMF, Tableau, Power BI and Access.
• Knowledge of Blue Cross and Blue Shield claim operations, policy, procedures, regulations, business procedures and facility operations is preferred.

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package:
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 5% 401(k) plan matching
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Posting Close Date

Pay Rate Type
Salary

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