Network Reimbursement Analyst II
$55,100–$103,810 year
RemoteUnited States
Job Summary
Research and analyze network reimbursement and payment issues to develop recommendations for correcting system and procedural changes. Coordinate the configuration and implementation of non-complex professional and facility provider pricing schedules, including rate calculations and preparation of rate change memos. Act as a subject matter expert to answer questions regarding payment and system configuration, determine the urgency of change requests, and manage unit projects to ensure timely completion. Assist in the development of reporting, queries, and studies to support network reimbursement initiatives while guiding the training of new analysts.
Required Qualifications
- Minimum of 2-3 years of experience with claims processing systems
- Facets experience
- Bachelor's Degree in business, healthcare, related field or comparable business experience
- Knowledge of medical terminology, NDC, HCPCS and ICD-9/10-CM coding structures
- Knowledge of Medicare reimbursement policies and methodology, including RBRVS (facility and professional provider reimbursement)
- Knowledge of Theon/Care Optimizer and Crystal Reporting, MVEP and other various reporting software
- Knowledge of Capital's principles of reimbursement, products, and procedures associated with claims processing (manual and electronic)
- Knowledge of Capital BlueCross provider contract provisions
- Knowledge of general accounting practices and auditing procedures/techniques
- Ability to analyze and interpret detailed reference manuals
- Demonstrated ability to effectively use Excel and database applications to retain and manipulate data
- Ability to effectively communicate in written and oral forums
- Demonstrated ability to prepare detailed reports that accurately communicate the issue/problem/situation and recommended action in a clear and concise manner
- Strong mathematical, analytical, research and organizational skills including a focus on detail
- Ability to work independently and schedule and manage time effectively
- Ability to perform in a team environment
- Familiarity of the operational aspects of providers
- Ability to work independently with minimal supervision including the organization and prioritization of tasks to meet prescribed deadlines and department goals
- Ability to recognize potential problem areas (those that materially affect reimbursement) and quickly differentiate between those which can be resolved directly versus those requiring assistance
- Must be able to professionally interact with all levels of the company, especially other staff within the various units in Provider Operations and the Provider Contracting areas
Desired Qualifications
- Minimum requirements include a Bachelor's Degree in business, healthcare, related field or comparable business experience
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