Remote Network Contracts & Reimbursement Analyst

Excellus Health Plan Inc.; City of Rochester (NY); On-site; USD 62,000 - 107,000; Full time

Benefits offered by this job

Remote work possibility

Job summary

Excellus Health Plan Inc. seeks a seasoned professional to advance provider networks within the contracting and administration team in Rochester, NY.

You will analyze provider reimbursement, negotiate contracts, and ensure compliance with regulatory requirements as part of the corporate strategy. Responsibilities include developing formal reimbursement recommendations, modeling financial implications, and presenting findings to internal and external stakeholders while maintaining member privacy

Qualifications

• Six years of provider network reimbursement or related experience.
• Two years of provider contracting or reimbursement analysis experience.
• Experience with provider reimbursement methodologies.
• Ability to draft, interpret and apply contractual language.
• Technical skills including modeling and financial analysis.

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 budgets and strategies.
• Interprets data to support provider network contracting and administration activities.
• Prepares and presents information, findings, and recommendations to stakeholders.
• Liaises with stakeholders to coordinate provider network contract work items and tracks progress.
• Engages in provider contract negotiations with providers and leadership.

Skills

Provider reimbursement methods

Contract negotiation

Financial modeling

Regulatory compliance

Data interpretation

Communication skills

Healthcare product knowledge

Problem solving

Education

Bachelor's degree in Health Care Administration or relevant field

Job description

Excellus Health Plan Inc. seeks a seasoned professional to advance provider networks within the contracting and administration team in Rochester, NY.

You will analyze provider reimbursement, negotiate contracts, and ensure compliance with regulatory requirements as part of the corporate strategy. Responsibilities include developing formal reimbursement recommendations, modeling financial implications, and presenting findings to internal and external stakeholders while maintaining member privacy