Job Information
Independence Blue Cross, LLC Senior Provider Reimbursement Analyst - 240240 in Philadelphia, Pennsylvania
Senior Provider Reimbursement Analyst - 240240
DESCRIPTION/RESPONSIBILITIES: Position Responsibilities: * Utilizing general understanding of reimbursement methodologies and trends in managed care finance, support the development of reimbursement and contracting strategies. * Working under general direction, perform provider reimbursement and contracting analyses to support provider network maintenance and development. * Translate complex and technical analyses into concise and easily understood findings to support contract, reimbursement and/or policy recommendations. * Works closely with provider contracting to memorialize negotiated reimbursement terms into rate exhibits and payment notes. * Leveraging detailed analyses, uses the findings to identify trend drivers and develop actionable items intended to adjust reimbursement levels to market levels leveraging available payment methodologies. * Working independently and/or as part of a team, identify and present cost avoidance and cost recovery opportunities. * Provide professional and technical assistance to internal and external customers, including, but not limited to, interpretation / implementation of regulations and contractual language, provider payment systems, and support for Blue Cross strategic initiatives. * Effectively communicate with customers project status, analysis findings, issue resolution to manage expectations. * May be responsible for acting as a team/project leader and training other staff in applicable areas of demonstrated expertise. * Performs other duties as assigned.
Position Qualifications * Bachelor's Degree in Business, Finance, Health Care Management, Information Science, or health-related field/commensurate work experience. Master's degree preferred. * Minimum 5 years progressive experience, preferably in managed care or provider environment. * Strong analytical, technical, and problem-solving skills. * Familiarity with managed care and/or Medicare reimbursement terms, concepts, and methodologies. * Excellent verbal and written communication skills required. Must be comfortable working with and presenting to all levels of management. * Ability to work independently and as part of cross functional teams. * Strong organizational skills and ability to manage multiple projects simultaneously. * Aptitude for detail-oriented work. * Strong interpersonal skills and the ability to work in a team environment required. * Advanced proficiency in the use of Microsoft Access, Excel, and Word. Must have experience manipulating and analyzing claims data and be familiar with reimbursement terms and concepts. Knowledge of SQL preferred.
Equal Opportunity Employer-minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity