• Reimbursement Analyst (Remote)

    CareFirst (Baltimore, MD)


    Resp & Qualifications

    PURPOSE:

    This position maty be responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare providers' reimbursement fee levels. The incumbent will work with various commercial and government program related fee schedules, develop recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks. Will be responsible for reviewing and analyzing information for various provider reimbursement and network strategy projects, preparing routine reports and fee disclosure related documents. Knowledge of Medicare or Medicare Advantage products preferred.

     

    We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.

    ESSENTIAL FUNCTIONS:

    + Work with claims data retrieved from a variety of sources via Excel and Access tools. Perform competitive financial analyses of the data, providing various scenarios and recommendations using negotiation strategies by various departments. Utilizing commercial and government program fee schedule benchmarks.

    + Work with CareFirst Commercial and Government Program fee schedules, participate in periodic review, provide scenarios for reimbursement models and alternatives. Make recommendations to management. Assist in developing pricing recommendations for services across the different fee schedules.

    + Respond to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching Medicare, Medicaid and other industry policies and reimbursement methodologies. Compile fee schedule disclosure files upon requests and pricing of daily claim inquiries from various internal platforms.

    QUALIFICATIONS:

    **Education Level:** Bachelor's Degree in HealthCare Administration, Business Administration, Finance or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

    **Experience:** 3 years doing financial analysis/modeling in the field of health insurance or health care.

    **Preferred Qualifications** :

     

    Understanding of national or local reimbursement mechanisms and methodologies.

    Knowledge, Skills and Abilities (KSAs)

    + Knowledge of Medicare and Medicare Advantage products and offering across the market.

    + Excellent verbal and written communication skills.

    + Excellent PC skills including intermediate to advanced level knowledge of Microsoft Access and advanced level knowledge of Microsoft Excel, and Microsoft Word.

    + Analytical and mathematical aptitude and have the ability to manage multiple tasks at the same time while prioritizing projects in order to accomplish departmental and corporate goals and objectives.

    + The ability to develop financial models/impact analyses and recommend action to management based on the results of those models.

     

    Salary Range: $53,424 - $106,106

     

    Salary Range Disclaimer

     

    The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

     

    Department

     

    Provider Payment and Regulator

     

    Equal Employment Opportunity

     

    CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

     

    Where To Apply

     

    Please visit our website to apply: www.carefirst.com/careers

     

    Federal Disc/Physical Demand

     

    Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

    PHYSICAL DEMANDS:

    The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

     

    Sponsorship in US

     

    Must be eligible to work in the U.S. without Sponsorship.

    \#LI-NH2

    REQNUMBER: 21609