6-month contract to possible hire

40 hours a week

POSITION PURPOSE

This position is responsible for providing entry level analytical support in the healthcare insurance reimbursement department that is responsible for managing hospital, physician and other healthcare

provider contracts governing billing and payments.

Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:

All levels of internal personnel, with primary contacts in Network Administration, Network Operations, IT, Medical Management, Benefits Administration and Medicare Advantage.

Providers, provider representatives, vendors and consultants to exchange or review program information. Other data sources are market research consultants, AMA, St. Anthony, HIAA,

CMS, Blue Cross and Blue Shield Association and Blue Cross and Blue Shield Plans.

QUALIFICATIONS

Education

• Bachelor's degree in statistics, accounting, finance, mathematics, health informatics or related field is required

• Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

• Six months of health care analysis, analytics, IT or management consulting experience.

• Professional level work experience in a provider office, health insurance reimbursement and/or financial analysis is preferred

• Experience with medical coding (ICD9, HCPCS, CPT4) is preferred

Experience interpreting, explaining, summarizing and making recommendations based upon research and statistical analysis (e.g. business case study recommendations, etc.) is

preferred

Skills and Abilities

Excellent analytical, oral and written communication, and report preparation skills with the highest degree of accuracy are required

Proficiency with Microsoft Excel including Pivot Tables and experience with either Microsoft Access or SQL Server for building queries and statistical reports required

Provides reimbursement assistance to Network Administration staff, Network Operations staff, Information Technology staff, Benefits Administration staff, Provider Audit staff by

developing and implementing project/program narratives and responding to concerns on new and existing reimbursement programs, billing guidelines, and system requirements to

ensure accurate implementation and maintenance of provider reimbursement programs, under the direction of the departmental director and working closely with more senior level

reimbursement staff. May serve on related committees.

•Identifies claims and provider reimbursement related system problems, including claims coding and processing issues, and coordinates research, audit, and recommendations with

Provider Audit, and implements and monitors system changes to resolve these problems, under the direction of the departmental director.

•Researches, designs, implements, and maintains moderately complex hospital or professional provider reimbursement programs, under the direction of the departmental director, within

corporate objectives on project implementation and schedule deadlines. Contacts other plans, consultants, and local providers to assist in program specifications.

•Analyzes and produces management reports to monitor effectives and identify and resolve deficiencies of reimbursement programs in comparison to industry benchmarks, competitors,

and Medicare.

•Utilizes financial pricing models and financial data analysis under the director of the department director to support modifications to reimbursement programs and assist management in

identifying deficiencies and monitoring effectiveness.

•Provides statistical reports to Network Administration, Medical Management, Marketing and Medicare Advantage staff to support internal strategies and external customer needs, such

as contract negotiations and marketing efforts.

•Responds to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching Medicare and other industry policies and reimbursement methodologies. Compiles fee

disclosure requests and pricing of daily claim inquiries from various sources.

•Additional Accountabilities and Essential Functions