Reimbursement Analyst (Remote)

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 53,928 - 107,107; Full time

Benefits offered by this job

Comprehensive benefits package

401k contribution programs

Job summary

CareFirst BlueCross BlueShield is seeking an experienced financial analyst for reimbursement policy development. This position involves analyzing healthcare provider reimbursement rates and developing strategies to ensure competitiveness. You will work primarily remotely within the greater Baltimore/Washington area but may need to attend meetings at CareFirst locations periodically.

The ideal candidate will have a Bachelor's degree or equivalent experience, and at least 3 years of experience in financial analysis, particularly within health insurance. The position offers a salary range of $53,928 - $107,107, along with benefits and a supportive work environment.

Qualifications

• Bachelor's degree in related field or additional 4 years experience.
• 3 years of financial analysis in health insurance or healthcare.
• Understanding of reimbursement methodologies for Commercial and Government Programs.

Responsibilities

• Construct and analyze claims data spreadsheets.
• Perform financial analyses to evaluate reimbursement rates.
• Respond to ad hoc requests for contract auditing and fee disclosure.

Skills

Financial analysis/modeling

Microsoft Excel (advanced)

Microsoft Access (intermediate to advanced)

Communication skills

Analytical aptitude

Education

Bachelor's Degree in HealthCare Administration, Business Administration, Finance

4 years relevant work experience

Tools

Microsoft Office Suite

Job description

PURPOSE

This position is responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and workflows for healthcare providers' reimbursement fee levels. The incumbent will develop recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks. Will be responsible for reviewing and analyzing information for various provider reimbursement and network strategy projects, preparing routine reports, claims resolve and fee disclosure related documents. May apply across Commercial and Government Program methodologies.

RESPONSIBILITIES & QUANTIFICATIONS

We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

ESSENTIAL FUNCTIONS

• Construct Excel spreadsheets and Access databases of claims data retrieved from a variety of sources. Perform competitive financial analyses of the data, providing various scenarios and recommendations using negotiation strategies by various departments.
• Perform detailed financial analyses of the claims utilization data to determine the competitiveness of CareFirst's various reimbursement rates, provide scenarios for reimbursement alternatives and make recommendations to management. Assist in developing pricing recommendations for services on the Professional Physician fee schedule.
• Respond to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching industry policies and reimbursement methodologies. Compile fee disclosure requests and pricing of daily claim inquiries from various sources.

QUALIFICATIONS

Education Level: Bachelor's Degree in HealthCare Administration, Business Administration, Finance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years doing financial analysis/modeling in the field of health insurance or health care.

PREFERRED QUALIFICATIONS

Understanding of national or local reimbursement mechanisms and methodologies for Commercial and Government Programs, such as Medicare or Medicaid.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs)

• Excellent verbal and written communication skills.
• Excellent PC skills including intermediate to advanced level knowledge of Microsoft Access and advanced level knowledge of Microsoft Excel, and Microsoft Word.
• Analytical and mathematical aptitude and have the ability to manage multiple tasks at the same time while prioritizing projects in order to accomplish departmental and corporate goals and objectives.
• The ability to develop financial models/impact analyses and recommend action to management based on the results of those models.

Salary Range

Salary Range: $53,928 - $107,107

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Provider Payment and Regulator

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc / Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.