Network Contract & Reimbursement Analyst (Remote-Eligible)

Excellus BlueCross BlueShield; Town of De Witt (NY); On-site; USD 62,000 - 107,000; Full time

Benefits offered by this job

Remote work possibility

Job summary

Excellus BlueCross BlueShield in New York is seeking a professional to contribute to the development and maintenance of provider networks within the network contracting and administration team. The role focuses on provider and network analysis, evaluating provider reimbursement, and negotiating contracts in line with corporate strategy.

The position requires knowledge of provider types, regulatory requirements, pricing methodologies, and market dynamics, with strong analytical and negotiation

Qualifications

• Strong, persuasive, and effective verbal and written communication skills.
• Excellent problem-solving skills.
• Technical skills including modeling and financial analysis.
• Understanding of medical care delivery, industry trends, and regional market dynamics.
• Knowledge of health care products and services offered to members.

Responsibilities

• Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
• Identifies, investigates, and analyzes issues and questions. Collects and interprets data and information to support provider network contracting and administration activities.
• Effectively prepares and presents information, findings, and recommendations to internal and external stakeholders.
• Serves as liaison with assigned stakeholders to identify and coordinate provider network contract and administration work items.
• Engages in provider contract negotiations. Works routinely and directly with providers, clinical, and operational leadership.
• Assist in the preparation of provider contracts, amendments, and communications.
• Maintains knowledge of relevant legislative and regulatory mandates to ensure compliance.
• Responds to and resolves inquiries from providers and colleagues related to provider network contracting and administration.
• Leads issue resolution with internal and external stakeholders.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Skills

Verbal communication

Written communication

Problem-solving

Financial analysis

Modeling

Healthcare market knowledge

Education

Bachelor’s degree in Health Care Administration or relevant field

Job description

Excellus BlueCross BlueShield in New York is seeking a professional to contribute to the development and maintenance of provider networks within the network contracting and administration team. The role focuses on provider and network analysis, evaluating provider reimbursement, and negotiating contracts in line with corporate strategy.

The position requires knowledge of provider types, regulatory requirements, pricing methodologies, and market dynamics, with strong analytical and negotiation