Network Reimbursement Analyst II

🕒 July 9

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $55.1k - $103.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• Functions as a primary support for teams responsible for the development and maintenance of Network pricing schedules and facility reimbursement. • Makes recommendations on the feasibility of procedural changes. • Acts as an advisor for the Network Provider Contracting and Network Analytics and Contract Support teams to answer questions relating to payment and system configuration around fee schedules and facility reimbursement. • Researches and analyzes Network reimbursement/payment issues and develops recommendations to improve or correct the situation. • Assists with the development and implementation of reporting, queries and studies to support new and existing Network reimbursement initiatives. • Coordinates the configuration and implementation of non-complex professional and facility provider pricing schedules including rate calculations and preparation of rate change memos for facility pricing as well as basic fee exceptions for professional providers.

🎯 Requirements

• Minimum of 2-3 years of experience with claims processing systems • Facets experience preferred • Knowledge of medical terminology, NDC, HCPCS and ICD-9/10-CM coding structures • Knowledge of Medicare reimbursement policies and methodology, including RBRVS • Knowledge of Theon/Care Optimizer and Crystal Reporting, MVEP and other various reporting software • Minimum requirements include a Bachelor’s Degree in business, healthcare, related field or comparable business experience.

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement