Reimbursement Data Analyst
Found in: beBee jobs US - 2 weeks ago
This position is eligible to work hybrid or 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
- Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
- Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
- Professional Growth Opportunities: Advance your career with ongoing training and development programs.
- Stability: 80 years of commitment, compassion, and community
- Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
- Performs supervisory and training functions of persons assigned to assist in execution of reimbursement and policy business functions.
- Produce listings of claims (based on a given set of criteria) to be researched for accuracy of claims payments.
- Responsible for reviewing claim information to ensure accuracy of claims payments to providers.
- Responsible for following through on adjustment of claims paid in error.
- Performs data analytics and develops pricing methodology solutions tailored to meet contract requirements.
- Supervises accuracy of provider data for pricing and processing of claims.
- Develops recommendations as to appropriate MAP levels at each annual review.
- Develops recommendations as to appropriate MAP levels for new provider networks and through affordability studies.
- Designs and prepares financial exhibits that detail "cost of MAP increases" proposed in annual review for use by Manager, Provider Reimbursement, Director of Medical Economics, or senior staff members.
- Works directly with the provider in the development of the study model used in the negotiation of acceptable reimbursement levels. Negotiates study model acceptable to provider or their representative.
- Coordinates reimbursement pricing file updates and provider payment record files.
- Coordinates the management of the networking process after creation of a working network with partner Blue Cross and Blue Shield Plan.
- Advises senior leadership on the health of payment integrity project portfolio and continuous alignment with future roadmap for on-going savings and enhanced member experience.
- Bachelor's degree in finance, Accounting, Mathematics, Statistics, Risk Management, Economics, Health Care or related degree or in lieu of degree 8 years managed care billing or pricing / financial analysis experience.
- 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 modelling.
- Experience in provider claim coding data ICD-10 (diagnosis and surgical), CPT (Current Procedural Terminology)
- Experience with and knowledge of the healthcare delivery system and the health insurance industry.
- Experience with Medicare professional pricing.
- Experience with software languages such as DBII, QMF or SQL.
- Knowledge of actuarial, compliance, information systems, and other health insurance administration concepts and principles.
BCBSKS Grade Exempt 16
Starting salary at $80,720
Salary determined based on education, skills and experience
Posting Close Date
April 8, 2024
Pay Rate Type
Salary
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