Pricing & Reimbursement Analyst I/II — Hybrid Healthcare

Cambia Health Solutions, Inc.; Fargo (ND); Hybrid; USD 49,000 - 98,000; Full time

Job summary

Cambia Health Solutions, Inc. is seeking a Pricing and Reimbursement Analyst I or II in a hybrid role (3 days in office) with opportunities across multiple offices. The position involves analyzing contract payments and reimbursement rates for providers, ensuring accurate contract payments negotiated by Regence.

Responsibilities include pricing, rate maintenance, and data analysis, with potential leadership in projects for Level II. A bachelor’s degree and healthcare experience are required.

Qualifications

• 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.
• Minimum of three years claims processing experience with knowledge of various methods of reimbursement.

Responsibilities

• Collaborate with Provider Services, Network Management, and operations staff to ensure negotiated payments are implemented accurately.
• Load and maintain rates in system files to price professional and facility claims for contracted providers.
• Research, analyze, and implement provider reimbursement methodologies industry-wide.
• Create payment exhibits attached to provider contracts and update CPT, DRG, HCPCS, ICD-9 changes.
• Identify over/underpayments, propose corrective actions, and coordinate implementations.
• Serve as liaison with internal departments to clarify contract and billing issues.
• Maintain hardware/software and support end-user processing guidelines.
• Participate in Regence Reimbursement Subcommittee and represent the plan at meetings.

Skills

Provider contracts

SQL query development

Microsoft Excel

Data analysis

Education

Bachelor's degree in business or related field

Tools

SQL

MS Access

Microsoft Office Suite

Job description

Cambia Health Solutions, Inc. is seeking a Pricing and Reimbursement Analyst I or II in a hybrid role (3 days in office) with opportunities across multiple offices. The position involves analyzing contract payments and reimbursement rates for providers, ensuring accurate contract payments negotiated by Regence.

Responsibilities include pricing, rate maintenance, and data analysis, with potential leadership in projects for Level II. A bachelor’s degree and healthcare experience are required.