Remote Network Contracts & Reimbursement Analyst

Excellus BCBS; Town of De Witt (NY); Hybrid; USD 62,000 - 107,000; Full time

Benefits offered by this job

Remote work possibilities

Job summary

Excellus BCBS in the United States is seeking a Network Contracting and Administration professional to develop and maintain provider networks, analyze reimbursement, and negotiate contracts in line with corporate strategy.

The role requires deep knowledge of provider types, regulatory requirements, pricing methodologies, and regional market dynamics to deliver accurate analysis and actionable recommendations to stakeholders.

Qualifications

• Six (6) years of provider network reimbursement or related experience OR a Bachelor’s degree in Health Care Administration or relevant field.
• Two (2) years of experience directly performing provider contracting or reimbursement analysis.
• Demonstrated experience of provider reimbursement methodologies.
• Ability to draft, interpret and apply contractual language.
• Technical skills including modeling and financial analysis.
• Understanding of medical care delivery, industry trends, and regional market dynamics.
• Strong, persuasive, and effective verbal and written communication skills.

Responsibilities

• Establishes and maintains network adequacy for assigned provider types, regions and/or lines of business.
• Serves as provider network contracting and administration subject matter expert for assigned areas.
• Analyzes, develops, and proposes formal provider reimbursement recommendations within approved budgets and according to health plan strategies.
• Identifies, investigates, and analyzes issues and questions; interprets data to support contracting activities.
• Prepares and presents information, findings, and recommendations to stakeholders.
• Engages in provider contract negotiations with providers, clinical and operational leadership.
• Assist in the preparation of provider contracts, amendments, and communications.
• Maintains knowledge of regulatory mandates to ensure compliance.

Skills

Provider network reimbursement

Contracting experience

Financial analysis

Contract interpretation

Communication skills

Education

Bachelor's degree in Health Care Administration

Job description

Excellus BCBS in the United States is seeking a Network Contracting and Administration professional to develop and maintain provider networks, analyze reimbursement, and negotiate contracts in line with corporate strategy.

The role requires deep knowledge of provider types, regulatory requirements, pricing methodologies, and regional market dynamics to deliver accurate analysis and actionable recommendations to stakeholders.