Pricing & Reimbursement Analyst — Data-Driven Impact

Jobtailor; Idaho; On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor in Idaho is seeking a Pricing & Reimbursement Analyst to help manage provider payments and contract pricing. You will load rates, price professional and facility claims, and analyze reimbursement methodologies to improve accuracy and efficiency.

The role requires a bachelor's degree in business or related field and several years of claims processing experience, with strong SQL, Excel, and data analysis skills to support pricing decisions and updates to coding standards.

Qualifications

• Bachelor’s degree in business or related field is required.
• Minimum three years claims processing experience with knowledge of reimbursement methods.
• Ability to read and apply provider contracts and pricing methodologies with accuracy.

Responsibilities

• Collaborate with Provider Services, Network Management, and operations to ensure negotiated payments are implemented correctly.
• Load and maintain rates in system files to price professional and facility claims for contracted providers.
• Research, analyze, and implement reimbursement methodologies industry-wide and support new strategies.
• Create payment exhibits for provider contracts and maintain CPT, DRG, AP-DRG, HCPCS, per diem, ICD-9 coding changes.
• Research contract and pricing issues, recommend corrective actions, and coordinate implementation.
• Participate in Regence Reimbursement Subcommittee and represent the plan at meetings.

Skills

Analytical ability

Strong communication

Attention to detail

Collaboration

Education

Bachelor’s degree in business or related field

Tools

SQL

Excel

Access

Word

Job description

Jobtailor in Idaho is seeking a Pricing & Reimbursement Analyst to help manage provider payments and contract pricing. You will load rates, price professional and facility claims, and analyze reimbursement methodologies to improve accuracy and efficiency.

The role requires a bachelor's degree in business or related field and several years of claims processing experience, with strong SQL, Excel, and data analysis skills to support pricing decisions and updates to coding standards.