Resp & Qualifications PURPOSE: This position is responsible for preparing analyses associated with the development of reimbursement policy, strategies, cost of care impacts and work flows for healthcare providers' reimbursement fee levels. The incumbent will develop recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks. Will be responsible for reviewing and analyzing information for various provider reimbursement and network strategy projects, preparing routine reports, claims resolve and fee disclosure related documents. May apply across Commercial and Government Program methodologies.
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.
ESSENTIAL FUNCTIONS:- 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.
QUALIFICATIONS: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.
Preferred Qualifications:
Understanding of national or local reimbursement mechanisms and methodologies for Commercial and Government Programs, such as Medicare or Medicaid.
Knowledge, Skills and Abilities (KSAs)- 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.
Salary Range: $53,928 - $107,107
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 Provider Payment and Regulator
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.
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