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Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:

Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

Annual incentive bonus plan based on company achievement of goals

Time away from work including paid holidays, paid time off and volunteer time off

Professional development courses, mentorship opportunities, and tuition reimbursement program

Paid parental leave and adoption leave with adoption financial assistance

Employee discount program

Job Description Summary:

The Provider Reimbursement and Content Analyst, Lead formulates and defines systems scope and objectives; and combines an understanding of applicable business systems and industry requirements. Must possess an in-depth understanding of the provider reimbursement business functions/processes supported, and be viewed as a knowledgeable representative of that business function/process. Serves as the primary relationship interface between IT, Operations, and the business; understanding contract and benefits language, specific technical NetworX configuration terms, and perform queries for claim impacts/provider identification/product networks. This role performs with minimal to no supervision and functions at the highest level of an individual contributor within the Provider Reimbursement job family.

Job Description

+ Proactively defines overall direction, roadmap and improvement actions for provider reimbursement applications that are core to the BlueKC business

+ Provides daily leadership, performance feedback, mentorship, training and coaching to a team of Reimbursement Analysts.

+ Communicates with team leads, management, IT, and business leadership to drive the coordination of processes across the enterprise

+ Ensures that governance, validation and quality processes are in place to support the highest level of accuracy within owned applications.

+ Validates the quality of work performed by staff in their functional area

+ Manages development of best practice NetworX configuration for complex contracting and negotiations for multiple provider payment methods.

+ Participates in developing As-Is and To-Be process flows

+ Creates and reviews test cases that are planned and executed. Participates in root cause analysis of defects found during testing

+ Performs feasibility analysis based on an understanding of proposed methodologies

+ Drives solutions of production issues based on an in depth understand of systems and systems functionality

+ Communicates business information, technical information and developments to users and technical staff in both verbal and written form; provides or coordinates feedback to management and/or users on all open issues

+ Uses data and other information to influence customers to the appropriate decision

+ Performs other related duties as assigned

Minimum Qualifications

+ Bachelor’s degree from an accredited university or college in Healthcare Administration, Business, Information Systems or a related academic field or an equivalent combination of education and experience

+ Demonstrated experience with payment methodologies, and network management experience for various provider types, specifically a minimum of 8 years in NetworX and a minimum of 5 years in Optum PPS

+ 5 years of experience interpreting complex contract language and intent specific to provider reimbursement

+ 4 years of experience working in the healthcare industry

+ 3 years extensive knowledge claims processing / billing

+ Experience with CMS methodologies

+ Experience in Microsoft Windows, Excel, Word, PowerPoint and Access (or similar applications) with the ability to create queries and advanced complex formulas

+ Working knowledge of medical terminology, code updates, data warehousing, operational systems, internet application concepts

+ Knowledge of the software development lifecycle and structured software development methodologies

Preferred Qualifications

+ Master’s degree in Healthcare Administration, Business, Information Systems or a related academic field

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us!

**Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to** [email protected] .

EOE/Veterans/Disability

Affirmative Action Employer

E-Verify Participation (https://bluekcmemberportal.azureedge.net/pdf/2024/E-Verify\_Participation\_Poster\_Eng\_Es.pdf)

Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies

IER Right to Work (https://www.e-verify.gov/sites/default/files/everify/posters/IER\_RightToWorkPoster%20Eng\_Es.pdf)

FMLA

Employee Polygraph Protection Act (https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf)