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Resp & Qualifications

PURPOSE:

This position will support the Pricing Administration Management department with NetworX Pricing. Implements provider pricing based on contracting, standard fee schedules, mandates and any projects and or corporate initiatives related to provider pricing. Analyzes business scope of work, determines appropriate systemic process, reporting analysis, conducting training, data validation for internal/external audits, and more.

ESSENTIAL FUNCTIONS:

+ Configures provider pricing by analyzing supporting documentation and determine appropriate methodology. Conducts root cause analysis to identify efficiencies and opportunities for improvement.

+ Identifies operational requirements by analyzing requirements and business needs; determining scope; documenting results; identifying phases and elements and ensuring provider data accuracy and procedural guidelines.

+ Collaborates with internal customers by frequent communication and status updates. May include conducting training; writing documentation; providing support and help.

+ Develop operation problem solutions by studying system capabilities; analyzing alternative solutions; preparing functional specifications to ensure reimbursement methodologies developed meets the needs of the business.

+ Review/Research operations systems by analyzing and resolving problems; reviewing system integrity and security; establishing and enforcing operation standards.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Business Administration 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:** 2 years experience as a Functional Analyst OR 4 years experience in (level 2 or above) operational role.

Preferred Qualifications Preferred:

+ 4 -5 years' experience in an operations role

Knowledge, Skills and Abilities (KSAs)

+ Highly proficient in Microsoft Office and similar applications.

+ Ability to create graphics and report to non-technical audiences.

+ Self-starter and ability to collaborate in a team environment.

+ Excellent communication skills both written and verbal.

+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

**Salary Range:** $54,504 - $108,251

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

Pricing Administration and Man

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-LY1

REQNUMBER: 21693