Network Contract Analyst

Job not on LinkedIn

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $63.4k - $119.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🛜 Network Engineer / Network Administrator

🦅 H1B Visa Sponsor

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

⚕️ Healthcare Insurance

💸 Finance

👥 B2C

Healthcare Insurance • Finance • B2C

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

• Perform contract administration activities including the preparation of contract settlements • Ensure claims are paid in accordance with contract provisions and plan payment levels • Perform research, analytic, and reporting work in support of Provider Contracting and Value Based Programs • Work with team manager and other analysts to develop and administer contracts with healthcare providers • Prepare provider contract settlements ensuring accuracy and compliance with payment provisions • Manage Cost Rate Adjustment (CRA) process • Respond to inquiries and resolve reimbursement issues from providers • Develop proactive analytical studies on provider billing patterns

🎯 Requirements

• 2-3 years’ experience in a health care environment with proven analytical expertise is desired • Proven understanding of Capital BlueCross provider contract provisions • Knowledge of general accounting practices and auditing procedures/techniques • Familiarity with Medicare and Medicaid reimbursement methodologies (facility and professional providers) • Demonstrated knowledge of and development experience with various tools such as Microsoft Office Suite products (Access, Excel, Word, etc.), Crystal Reports, Tableau, and SAS • Ability to perform at an intermediate skill level in Access including query development, table joins and formulas • Ability to perform at an intermediate level in Excel utilizing formulas, pivot tables and other functions/formulas

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Generous time off including Paid Time Off, Holidays, and Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible environment for health and well-being