Apply on Employer Site

CareFirst BlueCross BlueShield · 1 day ago

Reimbursement Analyst (Remote)

United States

Full-time

Remote

Mid Level

$53K/yr - $106K/yr

3+ years exp

CareFirst BlueCross BlueShield is a healthcare provider seeking a Reimbursement Analyst to prepare analyses related to reimbursement policies and strategies. The role involves working with claims data, conducting financial analyses, and making recommendations for reimbursement models and pricing strategies.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Work with claims data retrieved from a variety of sources via Excel and Access tools. Perform competitive financial analyses of the data, providing various scenarios and recommendations using negotiation strategies by various departments. Utilizing commercial and government program fee schedule benchmarks

Work with CareFirst Commercial and Government Program fee schedules, participate in periodic review, provide scenarios for reimbursement models and alternatives. Make recommendations to management. Assist in developing pricing recommendations for services across the different fee schedules

Respond to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching Medicare, Medicaid and other industry policies and reimbursement methodologies. Compile fee schedule disclosure files upon requests and pricing of daily claim inquiries from various internal platforms

Qualification

Financial analysisMedicare knowledgeMicrosoft ExcelMicrosoft AccessReimbursement methodologiesAnalytical skillsMathematical aptitudeVerbal communicationWritten communicationProject management

Required

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

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

Knowledge of Medicare and Medicare Advantage products and offering across the market

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