Pricing Reimbursement Analyst I or II (DOE)

Pricing Reimbursement Analyst I or II (DOE)

Telecommute Option - Must reside in ID, OR, UT or WA

WHO WE NEED

Pricing Reimbursement Analyst analyzes and implements contract payment terms and rates for all provider types, for all regions and subsidiaries. Pricing Reimbursement Analyst I is responsible for the analysis, development, and maintenance of contract payments for all institutional, facility, and professional healthcare providers negotiated by Regence.

Preferred Key Experience:

Excel (Mid - Advanced) / Pivot Tables

Provider Contracts

Facets / TOAD / Queries

Claims Pricing/Medicare Pricing or Reimbursement

eVips / PIMS / NetworkXpricer

Claims or Audit experience

YOUR ROLE

• Works closely with the Regence plans corporate business support Provider Services staff, and operations staff to ensure that negotiated payments for providers and institutions are implemented correctly and promptly.
• Responsible for loading and maintenance of rates into appropriate system files to correctly price professional and facility claims for contracted providers.
• Responsible for ensuring all programming changes for pricing and reimbursement are implemented correctly.
• Research, analyze, and implement provider reimbursement methodologies industry-wide and support the development of new reimbursement strategies.
• Maintain computer hardware and software and recommend purchase of new equipment/software packages to support pricing schedules and methodologies.
• Responsible for the creation of all payment exhibits attached to provider contracts.
• Serves as a liaison with the internal departments and divisions to ensure understanding of contract and billing issues from providers, hospitals and other contracted facilities.
• Responsible for updating and maintaining CPT, DRG, AP-DRG, HCPCS, per diem and ICD-9 software and coding changes and ensuring all programming changes for this pricing are implemented timely and correctly.
• Responsible for providing documentation to support end user processing guidelines.
• Research contract and/or pricing issues, which may result in over or underpayments to physicians or facilities; make recommendations on correction of issues. Once course of action determined, responsible for coordination & implementation of those changes.
• Serve as active participant on the local Regence plans Reimbursement Subcommittee. Also represents the Regence plan at various State or Regional meetings/committees.

WHAT YOU BRING

• Bachelor's degree in business or related field and at least two years experience in the health care industry, with one year of project related experience, or the equivalent combination of education and work experience.
• Minimum of three years claims processing experience with knowledge of various methods of reimbursement.
• Ability to maintain significant involvement in corporate projects, assuming a leadership role as necessary.
• Ability to read and interpret provider contacts and understand medical and hospital pricing methodologies and billing practices.
• Demonstrated ability to complete highly detailed tasks with accuracy in a timely manner. Strong attention to detail is required.
• Demonstrated ability to work independently with minimal supervision and ability to determine when manager approval or involvement is required.
• Good understanding of the applicable Regence plans system(s) pricing logic. The Level I person is characterized as a knowledgeable resource on pricing.
• Demonstrated ability to coordinate activities with varying levels of staff, with external agencies and medical professionals through strong verbal and written communication skills.
• Demonstrated analytical ability. Ability to identify problems, develop creative solutions and implement the chosen course of action in a timely and effective manner.
• Demonstrated maturity and tact, with the ability to be diplomatic and persuasive in situations requiring those qualities.
• Previous mainframe and PC experience is required.

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career focused on making the health care experience simpler, better, and more affordable for people and their families, consider joining our team at Cambia Health Solutions. Cambia is a total health solutions company that is deeply rooted in a 100-year legacy of transforming the industry and the way people experience health care. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future. Cambia is committed to delivering a seamless, personalized health care experience for the next 100 years.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.