Pricing and Reimbursement Analyst I/II

Cambia Health Solutions

Pricing and Reimbursement Analyst handling contract payment terms across healthcare providers. Collaborating with multiple teams to implement accurate reimbursement methodologies and processes.

Posted 7/28/2026full-timeSalt Lake City • Idaho, North Dakota, Oregon, Utah • 🇺🇸 United StatesJuniorMid-Level💰 $27,500 - $37,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Pricing and Reimbursement Analysis, with a strong ability to interpret provider contracts and medical pricing methodologies. Proficient in data analysis and problem-solving to ensure accurate claims processing and reimbursement strategies.

Highest-signal resume keywords

Pricing & Reimbursement AnalysisClaims Processing ExperienceProvider Contract InterpretationData Analysis & SQL Query DevelopmentStrong Verbal & Written Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingReimbursement MethodologiesCPT CodingDRG CodingAP-DRG CodingHCPCS CodingICD-9 CodingAnalytical Problem SolvingAttention to DetailCreative Solution Development

Soft Skills

Strong Communication SkillsCollaborationAttention to Detail

Tools & Technologies

Microsoft Office SuiteExcelWordAccessSQL

Industry Keywords

Health Care IndustryProvider ServicesNetwork ManagementReimbursement StrategiesPayment ExhibitsContract IssuesRegence Reimbursement Subcommittee

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Collaborate closely with Provider Services, Network Management, corporate business support, operations staff and others to ensure negotiated provider and institutional payments are implemented correctly and promptly.
Load and maintain rates in appropriate system files to accurately price professional and facility claims for contracted providers, ensuring all programming changes are implemented correctly and timely.
Research, analyze, and implement provider reimbursement methodologies industry-wide while supporting the development of new reimbursement strategies.
Responsible for creating all payment exhibits attached to provider contracts and maintaining updates to CPT, DRG, AP-DRG, HCPCS, per diem, ICD-9, and HCPCS coding changes.
Research contract and pricing issues that may result in over or underpayments, recommend corrective actions, and coordinate implementation of solutions.
Actively participate in the local Regence Reimbursement Subcommittee and represent the Regence plan at various state or regional meetings and committees.

Requirements

What you’ll need

Bachelor’s degree in business or related field and at least two years experience in the health care industry, with one year of project related experience, or the equivalent combination of education and work experience.
Minimum of three years claims processing experience with knowledge of various methods of reimbursement.
Level II position requires at least two years of direct Pricing & Reimbursement Analyst experience, with demonstrated expertise in this area.
Ability to read, interpret, and apply provider contracts, medical/hospital pricing methodologies, and billing practices with strong attention to detail and accuracy.
Demonstrated analytical ability to identify problems, develop creative solutions, and implement effective courses of action in a timely manner.
Strong verbal and written communication skills to coordinate activities across varying staff levels, external agencies, and medical professionals.
Proficient in Microsoft Office Suite (Excel, Word, and Access) and SQL query development, with a strong ability to analyze data, identify discrepancies, and validate that updates have been applied accurately and completely.

Benefits

Comp & perks

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.