Network Reimbursement Analyst II

Capital Blue Cross

Network Reimbursement Analyst developing and maintaining pricing schedules for healthcare providers at Capital Blue Cross. Collaborating with teams to implement policy changes and improve reimbursement processes.

Posted 6/3/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesJuniorMid-Level💰 $55,100 - $103,810 per yearWebsite

About the role

Key responsibilities & impact

Functions as a primary support for teams responsible for the development and maintenance of Network pricing schedules and facility reimbursement
Makes recommendations on the feasibility of procedural changes
Acts as an advisor for the Network Provider Contracting and Network Analytics and Contract Support teams
to answer questions relating to payment and system configuration
Researches and analyzes Network reimbursement/payment issues and develops recommendations to improve
Coordinates the configuration and implementation of non-complex professional and facility provider pricing schedules

Requirements

What you’ll need

Minimum of 2-3 years of experience with claims processing systems
Ability to analyze and interpret detailed reference manuals
Demonstrated ability to effectively use Excel and database applications to retain and manipulate data
Strong mathematical, analytical, research and organizational skills including a focus on detail
Knowledge of medical terminology, NDC, HCPCS and ICD-9/10-CM coding structures
Knowledge of Medicare reimbursement policies and methodology, including RBRVS
Minimum requirements include a Bachelor’s Degree in business, healthcare, related field or comparable business experience

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processing systemsExceldatabase applicationsmathematical skillsanalytical skillsresearch skillsorganizational skillsmedical terminologyNDC codingHCPCS coding

Soft Skills

attention to detailadvisory skillsrecommendation skills

Certifications

Bachelor's Degree