Senior Provider Reimbursement Analyst at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals.  If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

Position Responsibilities:

·       Utilizing general understanding of reimbursement methodologies and trends in managed care finance, support the development of reimbursement and contracting strategies.

·       Working under general direction, perform provider reimbursement and contracting analyses to support provider network maintenance and development.

·       Translate complex and technical analyses into concise and easily understood findings to support contract, reimbursement and/or policy recommendations.

·       Works closely with provider contracting to memorialize negotiated reimbursement terms into rate exhibits and payment notes.

·       Leveraging detailed analyses, uses the findings to identify trend drivers and develop actionable items intended to adjust reimbursement levels to market levels leveraging available payment methodologies.

·       Working independently and/or as part of a team, identify and present cost avoidance and cost recovery opportunities.

·       Provide professional and technical assistance to internal and external customers, including, but not limited to, interpretation / implementation of regulations and contractual language, provider payment systems, and support for Blue Cross strategic initiatives.

·       Effectively communicate with customers project status, analysis findings, issue resolution to manage expectations.

·       May be responsible for acting as a team/project leader and training other staff in applicable areas of demonstrated expertise.

·       Performs other duties as assigned.

Position Qualifications

·       Bachelor’s Degree in Business, Finance, Health Care Management, Information Science, or health-related field/commensurate work experience. Master’s degree preferred.

·       Minimum 5 years progressive experience, preferably in managed care or provider environment.

·       Strong analytical, technical, and problem-solving skills.

·       Familiarity with managed care and/or Medicare reimbursement terms, concepts, and methodologies.

·       Excellent verbal and written communication skills required. Must be comfortable working with and presenting to all levels of management.

·       Ability to work independently and as part of cross functional teams.

·       Strong organizational skills and ability to manage multiple projects simultaneously.

·       Aptitude for detail-oriented work. 

·       Strong interpersonal skills and the ability to work in a team environment required. 

·       Advanced proficiency in the use of Microsoft Access, Excel, and Word. Must have experience manipulating and analyzing claims data and be familiar with reimbursement terms and concepts. Knowledge of SQL preferred.

Hybrid

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.

 

 

Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

 

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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