Network Contract Analyst

🕒 July 6

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $63.4k - $119.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 26%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Assist in developing the team’s annual plan based on resources and anticipated workload • Perform analytical functions to administer provider contracts • Prepare accurate provider contract settlements reflecting contract payment provisions • Develop anticipated provider settlements and support adequate Plan reserves • Manage the Cost Rate Adjustment process, including data accumulation, reconciliation, investigation, analysis, and Special Pricing Factor review • Suggest and help revise provider contract administration workflows • Respond to provider questions concerning contracts, claims, reimbursement, cost reports, ownership changes, and service locations • Resolve and document reimbursement issues and communicate conclusions through appropriate channels • Draft contracts for new providers and amend existing contracts • Analyze data supporting provider contract negotiations • Represent the team in cross-departmental Plan projects involving provider reimbursement and contracting • Research and evaluate State and Federal payment modifications, mandates, demonstration programs, and initiatives • Conduct analytical studies of billing patterns, charge description masters, and reimbursement provisions • Analyze retroactive and prospective provider reimbursement impacts • Develop analyses to monitor provider billing practice changes • Respond to and provide documentation for internal and external claim payment audits and surveys • Coordinate configuration and implementation of professional provider pricing schedules and fee exception calculations • Audit work performed by others in Provider Operations • Assist with maintenance of pricing schedules aligned with network strategies

🎯 Requirements

• 2-3 years’ experience in a health care environment with proven analytical expertise is desired • Prefer a Bachelor's Degree in accounting, business administration, health planning and administration • Associate’s degree with sufficient level of work experience in health care or health care insurance pertaining to reimbursement or finance • Knowledge of Capital BlueCross provider contract provisions • Experience with Microsoft Office Suite, Access, Excel, Word, Crystal Reports, Tableau, and SAS • Intermediate Access skills including query development, table joins and formulas • Intermediate Excel skills using formulas, pivot tables and other functions/formulas • Working knowledge of claim and/or Facets data elements • Familiarity with provider claims submission requirements and reimbursement methodologies • Familiarity with Plan operations • Knowledge of general accounting practices and auditing procedures/techniques • Familiarity with Medicare and Medicaid reimbursement methodologies • Strong oral and written communication skills • Ability to work independently with minimal supervision and meet deadlines • Ability to perform provider contract analytics, data analysis, studies, and detailed reporting • Ability to understand database tables and data relationships • Ability to communicate professionally with provider financial personnel • Ability to manage multiple projects and priorities

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible environment • Training and continuing education • Community volunteer opportunities