Resp & Qualifications
This position is responsible for preparing analyses associated with the development of reimbursement policy, strategies, and work flows for healthcare providers’ reimbursement fee levels. The incumbent assists the Senior Reimbursement Analyst and/or Sr. Project Manager for Provider Reimbursement in developing recommendations and preparing competitive analyses to include industry, regional, and internal benchmarks. These recommendation and policies govern over $8 billion in professional and institutional care payments.
This position requires an understanding of physician and institutional reimbursement methodologies and processes, as well as CareFirst products and networks to develop critical cost of care impact analyses, financial reporting, and business cases to support corporate network strategies. The incumbent will be responsible for reviewing and analyzing information for various provider reimbursement and network strategy projects and preparing routine reports.
Construct Excel spreadsheets and Access databases of claims data retrieved from a variety of sources. Perform competitive financial analyses of the data, provide various scenarios alternatives, and recommendations for the Contracting departments. Complete detailed Quality Review of such data sources.
Perform detailed financial analyses of the claims utilization data to determine the competitiveness of CareFirst’s standard and provider specific reimbursement rates, provide scenarios for reimbursement alternatives and make recommendations to the Senior and/or Sr. Project Manager for Provider Reimbursement. Work with Senior and/or Sr. Project Manager for Provider Reimbursement to develop pricing recommendations for services on the Professional Physician fee schedule.
Respond to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching Medicare and other industry policies and reimbursement methodologies. Compile fee disclosure requests and pricing of daily claim inquiries from various sources.
Bachelor’s Degree in Finance, Business, Economics, or a related field (must have coursework and/or internship(s) that are relevant to the position). In lieu of a bachelor’s degree must have 4 years’ experience in business or healthcare related work environment.
• Intermediate level knowledge of Microsoft Excel, Microsoft Access and Microsoft Word.
• Ability to create database files and/or spreadsheets from large amounts of raw data.
• Be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
• Must be able to meet established deadlines within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service.
• 1-2 years of experience in financial analysis/modeling in the field of health insurance or health care.
• An understanding of national reimbursement mechanisms (CMS-1500, UB forms, ICD-10, PPS, CPT, HCPCS) as well as local regulatory environments.
• Analytical and mathematical aptitude in addition to excellent verbal and written communications skills.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 8/30/2020
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship