Description
• Performs pricing and transparency reporting functions to ensure adherence to Blue Cross Association and federal mandates to provide members with the cost of common medical procedures, surgeries, treatments, etc. as well as quality of care information.
• Supports facility and professional reimbursement areas through implementation of new processes, procedures, reports, software and the refinement of existing operations.
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• Collaborates with multiple cross-divisional business areas and vendors to improve reimbursement operations, solve organizational information challenges and build an efficient, effective and compliant technical analytical reporting infrastructure.
Requirements
• Bachelor’s degree in a related field, preferably in health care administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or related quantitative or health care field is required.
• Master’s degree such as MBA, MPH, MS or MA preferred
• 2 years of analytical experience in healthcare, IT, finance and/or other related industries required.
• Basic understanding of provider payment methodologies, complex provider contracts, medical coding, clinical editing, analytic driven healthcare pricing transparency initiatives or equivalent experience is preferred.
• Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. is preferred.
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