At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital, you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Network Contract Analyst

AnalystAnalystFull TimeRemoteTeam 1,001-5,000Since 1938H1B SponsorCompany Site LinkedIn

Location

Pennsylvania

Posted

25 days ago

Salary

$63.4K - $119.4K / year

Bachelor Degree2 yrs expExperience acceptedEnglishTableau

Job Description

• Perform contract administration activities encompassing preparation of contract settlements to ensure that claims are ultimately paid in accordance with the provisions of the contracts • Perform research, analytic and reporting work in support of the Provider Contracting and Value Based Programs ACA agreements, provider reimbursement strategies and new contracting initiatives • Work with team manager and other analysts to develop and administer contracts between Capital BlueCross and various providers • Assist in developing an annual plan for the team which considers available resources and anticipated workload • Responsible for the analytical functions necessary to effectively administer provider contracts • Prepare provider contract settlements ensuring accuracy • Manage the Cost Rate Adjustment process • Respond to questions and concerns raised by providers • Participate in drafting contracts for new and existing providers • Develop proactive analytical studies to assess changes in provider billing patterns and charge description masters • Perform audit functions on the work of others in the Provider Operations unit

Job Requirements

2-3 years’ experience in a health care environment with proven analytical expertise
Prefer a Bachelor's Degree in accounting, business administration, health planning and administration or an Associate’s degree with sufficient level of work experience in health care or health care insurance pertaining to reimbursement or finance
Knowledge of Capital BlueCross provider contract provisions
Demonstrated knowledge of various tools such as Microsoft Office Suite products (Access, Excel, Word, etc.), Crystal Reports, Tableau, and SAS
Ability to perform at an intermediate skill level in Access including query development, table joins and formulas
Ability to perform at an intermediate level in Excel utilizing formulas, pivot tables and other functions/formulas
Familiarity with the operational aspects of different provider types with an understanding of their claims submission requirements and provider reimbursement methodologies
Knowledge of general accounting practices and auditing procedures/techniques
Familiarity with Medicare and Medicaid reimbursement methodologies (facility and professional providers).