Provider Reimbursement Analyst

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13067518 Blue Cross and Blue Shield of Kansas is looking to add to our Medical Economics team and has an opportunity for a Provider Reimbursement Analyst. This position is responsible for designing, extracting, and analyzing large datasets from both internal and external sources while working closely with the Provider Analysis team. The information will be used to identify opportunities to reduce healthcare cost and utilization through provider reimbursement initiatives, such as Fee for Services Maximum Allowable Payments, and the Quality Based Reimbursement Programs (QBRP). Creates, maintains, and validates datasets to analyze current provider payouts, recommends future payment structures, and develops new payment networks as needed. This position is eligible to work hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. Why Join Us? Family Comes First : Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave. Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected. What youll do Assist with management of reimbursement activities related to proper MAP levels for services provided by providers or facilities. This involves developing technical studies, analyses and fiscal impacts that serve as a focal point in the presentation of pricing and methodologies of institutional and professional provider payment programs. Collaborate with cross-functional teams to integrate provider reimbursement strategies with broader financial and operational goals. Develops comprehensive studies that guide the presentation and implementation of new pricing and reimbursement methodologies. Work directly with providers and their representatives when needed in the study model review. Designs and prepares financial exhibits that detail \"cost of MAP increases\". Assists and conducts provider contract reimbursement and policy audits internal and external sources. Ability to develop queries that will be used to extract claim data to be researched for payment accuracy and perform claims recovery activities. Responsible for the development of reimbursement pricing file updates, provider payment record files, and payment listings shared with providers.