Network Reimbursement Analyst II

Role Description

The Network Reimbursement Analyst functions as a key analytical, reporting and implementation resource to the teams responsible for professional and facility provider reimbursement negotiations. The primary functions include:

• Research, data analysis, and reporting.
• Development, maintenance, and configuration of pricing schedules.
• Providing innovative approaches and solutions to non-complex provider reimbursement contractual issues.
• Final customer approval on uncomplicated system and procedural changes.

Responsibilities

• Functions as a primary support for teams responsible for the development and maintenance of Network pricing schedules and facility reimbursement.
• Makes recommendations on the feasibility of procedural changes.
• Acts as an advisor for the Network Provider Contracting and Network Analytics and Contract Support teams.
• Researches and analyzes Network reimbursement/payment issues.
• Assists with the development and implementation of reporting, queries, and studies.
• Coordinates the configuration and implementation of non-complex professional and facility provider pricing schedules.
• Manages non-complex unit projects and assignments.
• Guides and assists in the training of new analysts.
• Maintains a professional level of competence through continued education.
• Performs duties relating to the administration of contracts for certain facility providers.

Qualifications

• Ability to analyze and interpret detailed reference manuals.
• Demonstrated ability to effectively use Excel and database applications.
• Ability to effectively communicate in written and oral forums.
• Strong mathematical, analytical, research, and organizational skills.
• Ability to work independently and manage time effectively.
• Familiarity with the operational aspects of providers.
• Ability to recognize potential problem areas affecting reimbursement.

Knowledge

• Knowledge of medical terminology, NDC, HCPCS, and ICD-9/10-CM coding structures.
• Knowledge of Medicare reimbursement policies and methodology.
• Knowledge of Theon/Care Optimizer and Crystal Reporting.
• Knowledge of Capital’s principles of reimbursement and claims processing.
• Knowledge of general accounting practices and auditing procedures.

Experience

• Minimum of 2-3 years of experience with claims processing systems. Facets experience preferred.

Education and Certifications

• Minimum requirements include a Bachelor’s Degree in business, healthcare, related field, or comparable business experience.

Physical Demands

• Sedentary work involving significant periods of sitting, talking, hearing, keying, and performing repetitive motions.
• Work requires visual acuity to perform close inspection of written and computer-generated documents.

Other

• Must be able to professionally interact with all levels of the company.
• Performs other related duties and assignments as directed.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• Incentive Plan.
• Tuition Reimbursement.