Network Reimbursement Analyst II
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Job Description
Network Reimbursement Analyst developing and maintaining pricing schedules for healthcare providers at Capital Blue Cross. Collaborating with teams to implement policy changes and improve reimbursement processes.
Responsibilities:
- Functions as a primary support for teams responsible for the development and maintenance of Network pricing schedules and facility reimbursement
- Makes recommendations on the feasibility of procedural changes
- Acts as an advisor for the Network Provider Contracting and Network Analytics and Contract Support teams
- to answer questions relating to payment and system configuration
- Researches and analyzes Network reimbursement/payment issues and develops recommendations to improve
- Coordinates the configuration and implementation of non-complex professional and facility provider pricing schedules
Requirements:
- Minimum of 2-3 years of experience with claims processing systems
- Ability to analyze and interpret detailed reference manuals
- Demonstrated ability to effectively use Excel and database applications to retain and manipulate data
- Strong mathematical, analytical, research and organizational skills including a focus on detail
- Knowledge of medical terminology, NDC, HCPCS and ICD-9/10-CM coding structures
- Knowledge of Medicare reimbursement policies and methodology, including RBRVS
- Minimum requirements include a Bachelor’s Degree in business, healthcare, related field or comparable business experience
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off, Holidays, and Volunteer time off
- Incentive Plan
- Tuition Reimbursement
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