Independence Blue Cross · 5 hours ago
Provider Reimbursement Analyst - Hybrid (PA/NJ/DE)
Philadelphia, Pennsylvania
Full-time
Hybrid
Mid LevelIndependence Blue Cross is focused on enhancing the health and well-being of the communities it serves. The Provider Reimbursement Analyst is responsible for evaluating and maintaining reimbursement methodologies, conducting financial analyses, and collaborating with cross-functional teams to improve network performance.
Health CareHealth InsuranceInsuranceMedical
Responsibilities
Conduct comprehensive reimbursement analyses to assess payment accuracy, financial impacts, and market competitiveness across provider specialties and lines of business
Evaluate fee schedule methodologies, CMS updates, contractual payment models, and emerging trends to support the development of strategic reimbursement recommendations
Model alternative reimbursement scenarios to forecast financial outcomes and support internal decision‑making
Identify cost‑saving opportunities by analyzing trend drivers, aberrant billing patterns, and provider‑level cost variations
Convert negotiated contract terms into detailed rate exhibits, payment notes, and reimbursement configuration requirements to ensure accurate system loading
Validate contract reimbursement structures for consistency with internal policies, regulatory requirements, and financial assumptions
Working independently and/or as part of a team, identify and present cost avoidance and cost recovery opportunities
Partner with Contracting to ensure reimbursement language, rate structures, and effective‑date terms are clearly understood and properly documented
Collaborate with system configuration teams to ensure timely and accurate implementation of new or updated rate methodologies
Investigate reimbursement issues and payment discrepancies by reviewing claims data, contract details, and system logic
Provide clear resolutions, payment corrections, and preventive recommendations to avoid recurring issues
Support audits, compliance inquiries, and quality reviews by supplying reimbursement analyses, documentation, and clarifications
Produce reports, summaries, and presentations that translate technical results into actionable business insights
Perform additional responsibilities as required to support departmental goals, operational needs, and strategic initiatives
Qualification
Required
Bachelor's degree in Business, Finance, Healthcare Management, Information Science, or a related field; Master's degree preferred
Strong analytical and problem-solving skills
Advanced proficiency in Excel, Access, Word and SQL
Strong organizational skills and ability to manage multiple projects simultaneously
Excellent verbal and written communication skills required
Experience analyzing claims data, fee schedules, and reimbursement methodologies is required
Aptitude for detail-oriented work
Ability to work independently and as part of cross functional teams
Preferred
Master's degree
Company
Independence Blue Cross
The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
Founded in 1938
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Alexandra Jorgensen
Senior Vice President Human Resources
Joe Geist
SVP & Market President, National
Recent News
Home Health Care News
2026-01-14
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