Provider Reimbursement Financial Analyst

2 weeks ago


Des Moines, Iowa, United States Wellmark, Inc. Full time
Job Overview

Company Overview: Wellmark, Inc. is a mutual insurance organization dedicated to serving the needs of our policyholders across Iowa and South Dakota. With a legacy built on trust over the past 80 years, our focus is on the well-being of our members rather than profit. If you are enthusiastic about contributing to an organization that prioritizes its members and is committed to sustainability and innovation, we invite you to explore this opportunity.

Position Summary:

Role Overview: As a Financial Analyst specializing in Provider Reimbursement, you will be responsible for developing, executing, and sustaining reimbursement strategies for providers associated with Wellmark. This role involves financial reporting and analysis to support reimbursement initiatives, requiring a comprehensive understanding of contracting, claims payment processes, and payment policies. Building and nurturing strong collaborative relationships with the Health Network team is essential to enhance our support for providers.

Candidate Profile:

Key Attributes: The ideal candidate is a detail-oriented, analytical thinker with a strong capacity for conceptual thinking and long-term outcome anticipation. You will excel in identifying and implementing continuous improvement opportunities in provider reimbursement. Your role will involve supporting stakeholders with various data-related projects, leveraging your expertise while tapping into your creative problem-solving skills. You should be adept at extracting insights from data to effectively communicate and consult with stakeholders.

Qualifications:

Essential Qualifications:

  • Bachelor's degree or relevant work experience.
  • A minimum of 4 years of financial analysis experience; or 3 years with at least 1 year in the healthcare or health insurance sector.
  • Ability to forecast and analyze long-term reimbursement model outcomes.
  • Strong critical thinking and innovative problem-solving capabilities.
  • Excellent verbal and written communication skills.
  • Proficient in Microsoft Office, particularly Excel, with the ability to generate ad hoc reports.

Preferred Qualifications:

  • Experience in healthcare or health insurance industries.
  • Familiarity with provider reimbursement strategies.
  • Knowledge of claims processing.
  • Experience with data analysis tools such as Tableau, SAS EG, or SQL.
Responsibilities:

Key Responsibilities:

  • Support reimbursement initiatives by analyzing and calculating fee schedules for healthcare providers.
  • Conduct routine financial analyses for leadership to assess the effectiveness of reimbursement methodologies.
  • Develop and maintain professional relationships with Network Engagement and Health Network teams to ensure proactive communication.
  • Provide consultation and expertise in reimbursement guidance and payment policies to stakeholders.
  • Collaborate on data processing and system enhancements related to provider payments.
  • Perform additional duties as assigned.

Equal Opportunity Employer: Wellmark Blue Cross Blue Shield is committed to fostering a diverse workforce and does not discriminate based on race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity, or any other characteristic protected by law.


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