Note: The job is a remote job and is open to candidates in USA. CareFirst BlueCross BlueShield is a health insurance company serving healthcare providers and members. The Reimbursement Analyst will analyze claims and reimbursement data, develop financial models and competitive benchmarks, and recommend reimbursement strategies, pricing alternatives, and provider fee levels. The role also supports contract audits, RFI/RFP responses, policy research, and fee disclosure requests.
Responsibilities
- Construct Excel spreadsheets and Access databases of claims data retrieved from a variety of sources. Perform competitive financial analyses of the data, providing various scenarios and recommendations using negotiation strategies by various departments
- Perform detailed financial analyses of the claims utilization data to determine the competitiveness of CareFirst's various reimbursement rates, provide scenarios for reimbursement alternatives and make recommendations to management. Assist in developing pricing recommendations for services on the Professional Physician fee schedule
- Respond to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching industry policies and reimbursement methodologies. Compile fee disclosure requests and pricing of daily claim inquiries from various sources
Skills
- 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
- 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
- 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
- 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
- Must be eligible to work in the U.S. without Sponsorship
- Understanding of national or local reimbursement mechanisms and methodologies for Commercial and Government Programs, such as Medicare or Medicaid
Benefits
- Remote work from within the greater Baltimore/Washington metropolitan area, with periodic attendance at a CareFirst location for meetings, training and/or other business-related activities.
- A comprehensive benefits package.
- Various incentive programs/plans, subject to eligibility requirements.
- 401k contribution programs/plans, subject to eligibility requirements.
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