Senior Provider Reimbursement Specialist

2 days ago


Philadelphia, Pennsylvania, United States Independence Blue Cross Full time
Job Summary

We are seeking a highly skilled and experienced Senior Provider Reimbursement Analyst to join our team at Independence Blue Cross. This role will be responsible for supporting the development of reimbursement and contracting strategies, performing provider reimbursement and contracting analyses, and translating complex technical analyses into concise and easily understood findings.

Key Responsibilities
  • Develop and implement reimbursement and contracting strategies to support provider network maintenance and development.
  • Perform provider reimbursement and contracting analyses to identify trend drivers and develop actionable items to adjust reimbursement levels to market levels.
  • Translate complex technical analyses into concise and easily understood findings to support contract, reimbursement, and/or policy recommendations.
  • Work closely with provider contracting to memorialize negotiated reimbursement terms into rate exhibits and payment notes.
  • Provide professional and technical assistance to internal and external customers, including interpretation and implementation of regulations and contractual language.
  • Effectively communicate with customers project status, analysis findings, and issue resolution to manage expectations.
Requirements
  • Bachelor's Degree in Business, Finance, Health Care Management, Information Science, or health-related field/commensurate work experience.
  • 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.
  • 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.
Work Environment

This role is designated as a hybrid model, which consists of working in the office 3 days a week and remotely 2 days a week. The work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

Equal Opportunity Employer

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.



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