Excellus BCBS · 17 hours ago
Reimbursement Analyst I/II/ III
Utica, NY
Full-time
Onsite
Entry, Mid, Senior Level
$60K/yr - $107K/yrExcellus BCBS is a healthcare organization that is seeking a Reimbursement Analyst to analyze and support reimbursement strategies for physician, ancillary, and facility services. The role involves calculating provider rates, monitoring reimbursement trends, and ensuring compliance with internal policies and procedures.
Health CareHealth InsuranceNon Profit
Responsibilities
Supports reimbursement strategy and analysis through various duties included running data queries for analysis and evaluation of current to proposed reimbursement rates
Works with Provider Contracting on reimbursement implementations to ensure provider contracts are executed timely, accurately, and in compliance with all internal policies and procedures
Accountable to have all rate calculations peer reviewed, perform post production validation and following other quality controls that are aligned to various methodologies
Contractual Maintenance through supporting all internal and external audits related to physician, ancillary and facility reimbursements. These audits include charge creep, cost plus, outpatient formula, and capital audits, according to provisions of provider contracts. Communicate results of findings and initiates payment recovery / reimbursement. And then calculating and implementing rate adjustments and enhancements as necessary
Research and manage resolution of provider payment inquiries, disputes and issues
Participate and support all Compliance related Audits and requests including following all process documentation and updated as needed
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures
Regular and reliable attendance is expected and required
Performs other functions as assigned by management
Complete more complex models and analysis for financial impacts from provide reimbursement as well as helping to design alternative methodologies and arrangements
Assist with and evaluating and identifying cost savings opportunities and makes recommendations to management
Identifies deficiencies among staff, department processes, and documentation and develops training, suggests improvements, and initiatives changes and updates as appropriate
Serves as SME to outline and explain to other areas in the company how various reimbursement methodologies are implemented, advantages/disadvantages of methodologies and represents the department where needed
Leads internal and external stakeholders to new insight into opportunities and creates unified strategies with internal departments that meet our cost and quality management needs
Independently design, develop, and recommend alternative reimbursement arrangements, reports to support initiatives, and changes to process flows
Reviews complex claims, financial models, test results, and trends with providers and hospital system executives to resolve issues and identify improvement opportunities
Examines corporate wide trends and prepares this information to enable both senior management and our external customers to better understand, evaluate, and decide potential actions and probable impact
Facilitates cross-functional workgroups and internal and external meetings to determine actions to drive cost, quality, and process improvement
Acts as a consultative capacity to management at all levels to provide expertise in the determination of suitable approaches to reimbursement concerns, trends, or industry changes
Creates tools, controls, and automation to ensure quality and efficiency of team
Implements recommendations of system enhancements, processing guidelines, system and/or training documentation modifications
Qualification
Required
Bachelors Degree in related field required. In lieu of degree, six years of relevant experience required
Demonstrate strong analytic skills, including root cause analysis, along with capacity to identify business objectives and associated risks
Must have the ability to complete thorough research, exercise good judgment and work independently
Must have good, demonstrated interpersonal relations skills
Excellent written and oral communications skills required
Comprehensive working knowledge of software programs: Intermediate level Excel, Word, Power Point, Microsoft Access, SAS, Cognos, or other data extraction tool; and general knowledge of MS Outlook and ability to access internet web sites and databases
Three years of business experience including analysis, problem solving, and data extraction/modeling required. Previous experience in health-related field preferred
Demonstrated experience in pricing to include price calculation for otherwise non-sourced pricing structures
Strong familiarity with Healthcare Reimbursement Methodologies and their application
Demonstrated ability to interact effectively with providers and internal business partners
Seven (7) years of business experience including analysis, problem solving, and data extraction/modeling required. Previous experience in health-related field preferred
Experience having identified strategic opportunities through data and driving it toward measurable result
Demonstrated ability to interact effectively with external business partners, TPA's and Provider representatives
Demonstrated ability to make effective presentations to front line internal/external management or provider groups
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time
Ability to travel across the Health Plan service region for meetings and/or trainings as needed
The ability to hear, understand, and speak clearly while using a phone, with or without a headset
Preferred
Previous experience in health-related field preferred
Benefits
Participation in group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays
Company
Excellus BCBS
Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, is part of a family of companies that finances and delivers vital health care services to about 1.5 million people across upstate New York.
Founded in 1932
5001-10000 employees
H1B Sponsorship
Excellus BCBS has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (18)
2023 (12)
2022 (15)
2021 (17)
2020 (20)
Funding
Current Stage
Late StageLeadership Team
Jeremy Donath
Director, Provider Reimbursement Analytics & Operations
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