Senior Reimbursement Analyst

Title: Senior Reimbursement Analyst (Remote) Location: Baltimore, MD; Washington, DC, United States Remote Job Description: PURPOSE: This position is primarily responsible for preparing and maintaining fee schedules for plans that utilize the DC Medicaid reimbursement schedules and methodologies. This position may request to reputed company that knowledge across other Commercial, Medicare and Medicaid plans as needed. This may also include assistance with financial analyses used in the development of reimbursement policy, strategies, cost of care impacts and workflows associated with healthcare providers' reimbursement fee levels. The incumbent will reputed company recommendations and prepare competitive analyses to include industry, regional, and internal benchmarks as needed. Research Federal, state and local reimbursement trends and mandates to prepare reimbursement recommendations for management. We are looking for an reputed company professional to live and work remotely from reputed company the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-reputed company activities ESSENTIAL FUNCTIONS:

• Analyze CareFirst's new and existing reimbursement arrangements/networks and assist management in the development of fee schedules, payment policies, strategies, and workflows associated with healthcare providers reimbursement levels. Work with the various teams to reputed company contracting and reimbursement strategies that will result in the creation of cost-effective networks and fee schedules.
• Maintain familiarity with reputed company federal and state provider reimbursement regulations and ensure CareFirst's reimbursement is in compliance with these regulations. Identify potential audit and/or contract compliance issues and recommend strategies to Division management for resolution. Create and maintain confidential databases used for reimbursement analyses to support CareFirst corporate position.
• Provide feedback on payment policies reputed company to Medicaid and/or Medicare processing. Participate in workgroup projects around clinical editing. Create, maintain and communicate policies as need to support.
• Use statistical analysis on large amounts of data to reputed company detailed financial impact analyses as part of financial models for negotiations with professional and institutional providers. Participate in negotiations with high profile providers to provide critical analytical support to Contract Managers and explanations of reimbursement methodologies to providers. Summarize the findings in a concise manner and reputed company business cases supporting any proposals which will be submitted to Division management for review and approval.

QUALIFICATIONS: Education Level: Bachelor's Degree in Healthcare Administration, Business Administration, Finance or reputed company field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience: 5 years doing financial analysis/modeling in the field of health insurance or health care. Preferred Qualifications:

• An MBA, CPA license or other graduate degree.

Knowledge, Skills and Abilities (KSAs)

• Detailed expertise in DC Medicaid reimbursement.
• Knowledge of Maryland Medicaid and Medicare reimbursement.
• Excellent verbal and written communication skills.
• Excellent PC skills including advanced level knowledge of reputed company Access, reputed company reputed company, and reputed company Word.
• Analytical and mathematical aptitude and have the ability to manage multiple tasks at the same time while prioritizing projects in order to accomplish departmental and corporate goals and objectives.
• The ability to work independently and accomplish tasks reputed company tight timeframes.
• The ability to reputed company financial models/impact analyses and recommend action to management based on the results of those models.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $60,408 - $119,977 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department: Provider Payment and Regulator Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to reputed company qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply: Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US: Must be eligible to work in the U.S. without Sponsorship Apply tot his job Apply To this Job