Reimbursement Analyst

The Reimbursement Analyst is responsible for developing and maintaining Blue Cross Blue Shield of North Dakota's (BCBSND) reimbursement programs, rates and policies within assigned treatment groups for hospitals, clinics, physicians and other provider groups who provide services to BCBSND members. This position conducts ongoing analysis of reimbursement programs and prepares input for use during the update of reimbursement schedule and provides support to internal partners and to providers and members regarding appropriate payments for services.

Essential Functions

• Conducts ongoing analysis of current reimbursement models and schedules and proposed changes to determine impact to the Plan and to the provider community. Develops methodologies to pay providers for services that are either new or are scheduled to be reimbursed in a different manner. Analyzes the effects that changes created by external factors are projected to have on the reimbursement models used in the rate setting process.
• Reviews, analyzes claims and provides support to internal and external customers on issues regarding the appropriate application of payment policies/fee schedules.
• Identifies system errors and/or problems and develops corrections or updates to the system. Participates in meetings/conversations with providers regarding specific coding/billing questions or concerns. Works with internal departments in reviewing pricing/coding. Assists other departments in their work in establishing new covered services or pilot programs.
• Works with internal departments to provide technical reimbursement advice. Responds to requests from other areas for pricing verifications.
• Reviews and recommends changes to processes within the department. Audits proposed reimbursement rates in both the test and production environments to ensure that the correct fees will be paid to providers.
• Provides education to internal departments and external customers on areas identified by various departments' input and interactions with providers.
• Prepares Health Care News articles, participates in webinars, conference calls and other educational forums with providers and presents information to outside professional groups as requested.
• Provides support to the coding area including, but not limited to: preparing information that the coders use for new or revised codes, provides assistance with profile/reimbursement related questions and assists in diagnosis-related group (DRG) pricing reviews.

Requirements

Knowledge, Skills and Abilities

Analytical Thinking

Intermediate

Task and Goal Focus

Intermediate

Organizational Understanding

Basic

Communication (Verbal/Written)

Intermediate

Technical/Professional Knowledge and Skills

Intermediate

Education Requirements

Required: Bachelor's

Preferred: Bachelor's

Field(s) of Study: Accounting, Finance, Business, Healthcare Administration or related field

Experience Requirements

Required: Minimum of 2 Years

Preferred: Minimum of 3 Years

Experience Details: Minimum of 2 years of experience in a health care financial setting is required; experience with Medicare Cost Reporting is preferred.

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

OTHER INFORMATION

Job Posting Policy 6.05

New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.



EQUAL OPPORTUNITY EMPLOYMENT



Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 1/25/2019 at 8:00AM CST. No further applications will be considered.