Reimbursement Data Analyst

Found in: beBee jobs US - 2 weeks ago


Topeka, Kansas, United States Blue Cross and Blue Shield of Kansas Full time
The Professional Provider Reimbursement Data Analyst will design, extract, and analyze large datasets from both internal and external sources. 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). The information will be used by Senior Management for strategic planning associated with reimbursement levels as part of provider networks and contracts. Data sets created, maintained, and tested to analyze current provider payout, recommend future payment structures, and develop new payment networks as needed.

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
What you'll do
  • 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.
What you need
  • 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)
Bonus if you have
  • 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.
Compensation

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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