Network Reimbursement Analyst

Overview

St. Luke's Health Partners is a clinically integrated network with about 300,000 attributed members across Idaho. We are committed to advancing value-based care by improving outcomes, enhancing patient experience, and reducing costs through data-driven insights and actionable analytics.

The Network Reimbursement Analyst is responsible for developing, maintaining, and updating SLHP's fee schedule, pricing updates, and reimbursement policy execution. The role evaluates Medicare and industry changes, translates coding and regulatory updates into pricing recommendations, and models the financial impact of reimbursement decisions on provider performance and network affordability.

Full-time or part-time option

What You Can Expect:

• Support the development, updates, and maintenance of SLHP professional and facility fee schedules by applying established pricing methodologies (percent-of-Medicare, custom rates, case rates, blended models) and ensuring accuracy across annual update cycles.

• Monitor and interpret Medicare updates, CPT/HCPCS changes, RVU shifts, APC/DRG refinements, modifier rules, NCCI edits, and payer policy changes; prepare analytical summaries and recommended pricing adjustments.

• Build and maintain models using claims, clinical, and operational data to evaluate the financial and operational impact of reimbursement changes on provider revenue, medical spend (PMPM), site-of-service patterns, and value-based care programs.

• Prepare scenario models, forecasts, dashboards, and ad-hoc analyses to support payer contracting, strategy development, and network performance monitoring.

• Perform post-claims audits, confirm alignment with fee schedules and reimbursement policies, and collaborate with Data & Analytics teams to validate datasets and ensure analytical reliability.

• Collaborate with contracting, provider relations, finance, and analytics partners to provide reimbursement insights and communicate findings clearly to a variety of stakeholders.

• Document pricing logic, analytic assumptions, data sources, and methodologies; contribute to analytical best practices and team knowledge-sharing.

Qualifications:

• Bachelor's degree or experience in lieu of degree

• 4 years' relevant experience

Remote work supported from the Idaho, Oregon, Utah, and Arizona ONLY

What's in it for you

At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.

Default: Location : City Boise

Category Data & Analytics

Work Unit SLHP Admin Salaries Only System Office

Position Type Full-Time

Work Schedule DAY

Requisition ID 2025-107707

Default: Location : Location US-ID-Boise

Work Location : Name 701 Morrison Knudsen Dr, Boise, St Luke's Plaza 2