Remote Payment Policy Analyst - Health Plan Reimbursement

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 58,320 - 115,830; Full time

Job summary

CareFirst BlueCross BlueShield is seeking a Payment Policy Analyst to research, develop, and coordinate payment policies supporting provider contracts, claims adjudication, and regulatory standards. Based remotely in the Baltimore area, with periodic travel to CareFirst locations for meetings and training.

The role requires a Bachelor’s degree or equivalent experience, three years in payment policy or related fields, and professional coding certifications.

Qualifications

• Bachelor’s degree or equivalent experience required; four additional years of relevant work experience in lieu.
• Certification required: CCS or CPC or AHIMA CCS.
• At least 3 years of experience in payment policy, reimbursement policy, or related areas.
• Preferred knowledge: CPT, HCPCS, ICD-10-CM/PCS coding systems and relevant reimbursement rules; writing and econometrics/statistics exposure.
• Strong ability to analyze complex information and communicate clearly; proficient with MS Office; familiarity with payer policies and claims processes.

Responsibilities

• Research in-depth on actual or potential payment policies; evaluate CMS guidance and industry references.
• Write evidence-based payment policies and procedures for reimbursement, coding, and regulatory mandates.
• Maintain the Payment Policy Reference Manual and disseminate policies to implementation teams; respond to inquiries.

Skills

Analytical thinking

Written communication

Verbal communication

Cross-functional collaboration

MS Office proficiency

Coding knowledge

Education

Bachelor’s Degree in Health Administration, Business, Finance, Nursing or related discipline / 4 years of relevant work experience

Job description

CareFirst BlueCross BlueShield is seeking a Payment Policy Analyst to research, develop, and coordinate payment policies supporting provider contracts, claims adjudication, and regulatory standards. Based remotely in the Baltimore area, with periodic travel to CareFirst locations for meetings and training.

The role requires a Bachelor’s degree or equivalent experience, three years in payment policy or related fields, and professional coding certifications.