Provider Reimbursement Analyst
4 weeks ago
Blue Cross and Blue Shield of Kansas is seeking a skilled Provider Reimbursement Analyst to join our Medical Economics team. As a key member of our team, you will play a crucial role in designing, extracting, and analyzing large datasets from internal and external sources to identify opportunities to reduce healthcare costs and utilization through provider reimbursement initiatives.
Key Responsibilities:- Develop technical studies, analyses, and fiscal impacts to inform pricing and methodologies for institutional and professional provider payment programs.
- Collaborate with cross-functional teams to integrate provider reimbursement strategies with broader financial and operational goals.
- Design and prepare financial exhibits to detail cost of MAP increases.
- Assist with provider contract reimbursement and policy audits, and conduct claims recovery activities.
- Develop queries to extract claim data for payment accuracy and perform claims recovery activities.
- Bachelor's degree in finance, accounting, mathematics, statistics, risk management, economics, healthcare, or a related field.
- At least three years' experience in healthcare reimbursement, managed care billing and pricing, applied mathematics, financial economics, or a related field.
- Experience with data warehouse structures, data extraction tools, analytics software and methods, and data modeling.
- Advanced analytical, problem-solving, and strategic thinking skills.
- Proficient in SQL and capable of learning additional programming languages as needed.
- Experience with Microsoft Word, Excel, QMF, Tableau, Power BI, and Access.
- Knowledge of Blue Cross and Blue Shield claim operations, policy, procedures, regulations, business procedures, and facility operations.
- Competitive salary range: $80,720 - $96,000.
- Exempt Grade 16.
- Excellent benefits package, including health, vision, and dental insurance, 6 weeks paid parental leave, fertility/adoption assistance, 2 weeks paid caregiver leave, 5% 401(k) plan matching, tuition reimbursement, and health & fitness benefits.
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