Network Reimbursement Analyst II

About the role

The Network Reimbursement Analyst functions as a key analytical, reporting and implementation resource to the teams responsible for professional and facility provider reimbursement negotiations. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital BlueCross at the time of posting and may be modified in the future.

Responsibilities

• Researches and analyzes Network reimbursement/payment issues and develops recommendations to improve or correct the situation.
• Aids in the development and implementation of reporting, queries and studies to support new and existing Network reimbursement initiatives.
• Coordinates the configuration and implementation of non-complex professional and facility provider pricing schedules including rate calculations and preparation of rate change memos for facility pricing as well as basic fee exceptions for professional providers for all lines of business.
• Maintains a professional level of competence through continued education and exposure to technologies/methodologies.
• Manages non-complex unit projects and assignments.
• Acts as a subject matter expert regarding professional and facility provider pricing methodologies and coordinates and manages unit resources assigned to projects to ensure the timely completion of tasks.
• Reports status of projects to unit manager and makes decisions during the life cycle of a project to enable a successful completion.
• Guides and assists in the training of new analysts to develop a thorough knowledge of job tasks and requirements.
• Performs duties relating to the administration of contracts for certain facility providers, including, but not limited to, the development of contract settlements and the review of the payment levels for propriety.

Qualifications

• Minimum of 2-3 years of experience with claims processing systems. Facets experience preferred.
• Minimum requirements include a Bachelor’s Degree in business, healthcare, related field or comparable business experience.
• Must be able to professionally interact with all levels of the company, especially other staff within the various units in Provider Operations and the Provider Contracting areas.

Skills

• 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.
• Ability to work independently and schedule and manage time effectively.
• Ability to perform in a team environment.
• Familiarity of the operational aspects of providers.
• Ability to work independently with minimal supervision including the organization and prioritization of tasks to meet prescribed deadlines and department goals.
• Ability to recognize potential problem areas (those that materially affect reimbursement) and quickly differentiate between those which can be resolved directly versus those requiring assistance.

Knowledge

• Knowledge of medical terminology, NDC, HCPCS and ICD-9/10-CM coding structures.
• Knowledge of Medicare reimbursement policies and methodology, including RBRVS (facility and professional provider reimbursement).
• Knowledge of Theon/Care Optimizer and Crystal Reporting, MVEP and other various reporting software.
• Knowledge of Capital’s principles of reimbursement, products, and procedures associated with claims processing (manual and electronic).
• Knowledge of Capital BlueCross provider contract provisions.
• Knowledge of general accounting practices and auditing procedures/techniques.

Benefits

At Capital BlueCross, we offer a comprehensive benefits package including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

Pay

The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital BlueCross at the time of posting and may be modified in the future.

Schedule

Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions.