Provider Reimbursement Analyst

4 weeks ago


Topeka, Kansas, United States Blue Cross and Blue Shield of Kansas Full time
Provider Reimbursement Analyst Opportunity

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.
Requirements:
  • 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.
Preferred Qualifications:
  • 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.
What We Offer:
  • 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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