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

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).

Benefits

Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off, Holidays, and Volunteer time off
Incentive Plan
Tuition Reimbursement
And more

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

contract administrationanalytical functionsprovider contract settlementsCost Rate Adjustment processaudit functionsquery developmenttable joinsformulaspivot tablesgeneral accounting practices

Soft Skills

analytical expertiseteam collaborationcommunicationproblem-solvingorganizational skills

Certifications

Bachelor's Degree in accountingBachelor's Degree in business administrationBachelor's Degree in health planning and administrationAssociate’s degree in health care