Provider Reimbursement Analyst
Provider Reimbursement Analyst
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Salary Not Disclosed
1 Vacancy
Job Description
About the role: As an Analyst for Provider Reimbursement you will create implement and maintain provider reimbursement strategies including financial reporting and analysis for all providers contracted with Wellmark. This includes supporting provider reimbursement initiatives by applying your thorough understanding of contracting claims payment procedures and payment policy. Collaboration is key so building and maintaining strong business relationships with other Health Network team members at Wellmark will be important to enhance the support we deliver to our providers.
About you: You are a critical thinker detail-oriented and analytical to your core. You are skilled at thinking conceptually anticipating long-term outcomes and identifying and implementing continuous improvement opportunities around provider reimbursement. You enjoy supporting stakeholders with ad hoc requests and tackling data-related projects because it allows you to use your expertise while tapping into your creative side. You are skilled in creating and communicating insights from data to help tell the story and consult with stakeholders. Hospital and/or health care facility reimbursement experience preferred. Top candidates will have experience with Tableau SAS EG and/or SQL.
This position will work a hybrid schedule of at least 3 days in Wellmarks Des Moines office (Tuesday-Thursday) with Monday & Friday remote option.
Internal Job Title: Network Economics Analyst
Qualifications :
Preferred Qualifications - Great to have:
- Bachelors degree.
- Healthcare health insurance or related industry experience.
- Knowledge of Wellmark and/or national recognized provider reimbursement strategies.
- Understanding of Wellmark products policies and processes to ensure consistency in the reimbursement strategies designed and implemented.
- Claims processing knowledge.
- Tableau SAS EG and/or SQL experience.
Required Qualifications - Must have:
- Bachelors degree or direct and applicable work experience.
- 4 years of financial analytical experience; OR 3 years of financial analytical experience with 1 year of health care health insurance or related industry experience e.g. provider payment/ reimbursement finance etc.
- Demonstrates ability to anticipate and analyze long-term reimbursement model outcomes.
- Excellent critical thinking and creative problem-solving skills. Uses data to inform decisions.
- Strong conceptual strategic thinking skills.
- Identifies and implements continuous improvement opportunities.
- Strong verbal/written communications skills. Articulates complex technical information effectively.
- Effectively builds relationships influences and solicits cooperation from others.
- Proactive self-starter with strong organizational prioritization and time management skills as well as excellent attention to detail.
- Proficient with Microsoft Office including Excel. Able to run queries and develop ad hoc reports.
Additional Information :
What you will do:
a. Support provider reimbursement initiatives by reviewing and calculating fee schedules paid to health care providers. Research document monitor and implement provider reimbursement related activity and initiatives including financial reporting and comprehensive data analysis.
b. Perform routine financial analysis for Wellmark leadership to monitor reimbursement methodologies for effectiveness. Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations as appropriate. Perform data modeling to assist providers understanding of methodology changes/updates.
c. Develop and maintain positive professional relationships with Network Engagement and Health Network to provide proactive communication of changes. Provide timely response to provider inquiries via Network Engagement and support data needs and inquiries. May communicate and attend provider meetings if applicable.
d. Serve as consultant in collaboration with Network Engagement to provide reimbursement guidance/expertise and payment policies to providers and applicable stakeholders.
e. Configure transfer and monitor data that is being processed in the provider payment systems. Collaborate with testing and system implementations and enhancements. Provide business knowledge and payment processing expertise in projects if applicable.
f. Other duties as assigned.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit hire train and promote individuals in all job classifications without regard to race color religion sex national origin age veteran status disability sexual orientation gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at
Please inform us if you meet the definition of a Covered DoD official.
Remote Work :
No
Employment Type :
Full-time
Employment Type
Full-time
