16 days old

Provider Reimbursement Analyst

Independence Blue Cross LLC
Philadelphia, PA 19107
  • Job Code
    210352

Job Summary





The Professional Reimbursement Analyst assists with the financial analysis required to support active negotiations and the development & implementation of a physician reimbursement strategy designed to fairly compensate providers across IBCs networks who deliver services to our members. The Professional Reimbursement Analyst assists with the analytical support required to determine both the reasonableness and impact of adjusting the reimbursement structure for community, large physician groups and those professional groups within an Integrated Delivery Service (IDS) providers. The Professional Reimbursement Analyst provides support to the Professional Reimbursement Manager in completing all reimbursement related tasks as well as any other tasks that may be assigned from time to time.



Responsibilities





  • Perform unit cost and contract valuation analysis in support of network contract negotiations and unit cost management strategies

  • Assist with the development and maintenance of financial models intended to assess the competitiveness of Independences reimbursement given internal/external bench marks and third-party data.

  • Develop baselines models that will determine for a physician group their current spend and rate relativities as compared to Independences prevailing fee schedule and CMS.

  • Perform trending analytics that measure medical and administrative costs

  • Develop and track financial targets for physician contracts-measure projections against actuals

  • Assist and handle special projects as necessary

  • Support contracting implementations in terms of ensuring the accuracy and completeness of rate load instructions in a timely manner given contractual requirements

  • Formulates cost avoidance and cost recovery opportunities through detailed analyses, identifying actionable information and resolving issues



Qualifications



Education



  • BS in Accounting, Finance, or Business Administration required.







Experience, Knowledge, & Skills



  • Minimum 3-5 years experience in healthcare/insurance with 1-2 years experience in financial analysis - provider reimbursement.

  • Understanding of Highmark systems preferred.

  • Outstanding quantitative financial analysis and qualitative reasoning capabilities.

  • Proficiency in SQL, Microsoft Excel and Access.

  • Excellent communication skills.

  • Strong attention to detail.






Posted: 2021-06-08 Expires: 2021-07-07
Sponsored by:
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Sponsored by:
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Provider Reimbursement Analyst

Independence Blue Cross LLC
Philadelphia, PA 19107

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