Job Description
Please email hr_business_partners@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Salary Range: $76,600 - $91,900
Type of position: Hybrid or Remote
Jump into the new world of health insurance:
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that’s large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.
Join others who know diversity is strength:
We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.
Why this job matters:
Analyze approved contract specifications and ensure calculated provider fee schedules, reimbursement methodology, and provider contracts are prepared for system configuration according to approved standards. Facilitate the implementation and verification of provider fee schedules. Coordinate new reimbursement methodologies with internal business areas and coordinate pricing updates to provider systems in accordance with our contractual commitments. Develop physician fee schedules by specialty.
What you’ll do:
- Work with appropriate business areas to ensure calculated provider fee schedules, reimbursement methodology and negotiated provider rate contracts are prepared for system configuration according to approved standards.
- Keep current on federal Medicare payment level updates and research potential impact of new or proposed Medicare methodology changes.
- Provide responses to internal departments and external providers regarding claims and reimbursement issues.
- Coordinate new reimbursement methodologies with internal business areas. Coordinate and oversee the pricing updates to systems for hospitals, physicians, and other providers in accordance with our contractual commitments with the provider pricing area. Develop physician fee schedules by specialty, including coordinator of fee schedules loaded on the web.
- Lead department initiatives and projects as assigned. Serve as department representative and participate on projects related to company reimbursement policies.
- Develop and maintain operational controls to ensure timely and accurate configuration of all reimbursement methodologies and provider contracts.
- Review pricing and configuration system testing to ensure appropriate application of provider fees, discounts and/or negotiated exceptions.
- Provide feedback on system errors and assist with the identification of trends. Prepare reporting for internal stakeholders.
- Lead process to measure compliance and quality, to ensuring ongoing integrity of information and provider payments.
- Maintain department manuals and internal training materials; ensure processes are consistent with company policies, state and federal guidelines.
- Participate in department or company-wide initiatives and projects.
- Monitor offshore performance in completing rate configuration and related pricing requests.
- Perform other duties as assigned.
What you need to succeed:
- Experience in Finance, Healthcare Administration, or related field, or an equivalent combination of education and work experience
- Three to five years of experience in contracting or reimbursement activities
- Certified Professional Coder (CPC) Certification or related coding certificate preferred
- Knowledge in CMS coding and reimbursement payment systems (professional, hospitals, other ancillary provider types)
- Extensive Knowledge of claims systems; experience with Facets a plus.
- Knowledge of provider fee schedules
- Advanced analytical skills, with the ability to interpret and synthesize complex data sets
- Advance Excel knowledge
- Microsoft Access knowledge
- Problem solving skills
- Strategic and critical thinking skills
- Knowledge of business process improvement techniques and strategies
- Excellent verbal and written communications skills
- Project Management skills, ability to handle multiple priorities/projects
- Presentation skills
- Strong decision-making skills
- Ability to interface with employees at all levels
- Ability to effectively navigate ambiguous situations with limited direction
- Excellent organizational skills and ability to successfully prioritize multiple tasks
Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department.
o. Arizona, Connecticut, Florida, Georgia, Louisiana, Maine, Massachusetts, Nevada, New Hampshire, North Carolina, Pennsylvania, Rhode Island, South Carolina, Texas, Virginia
Other important information:
Blue Cross & Blue Shield of Rhode Island has a COVID-19 vaccination requirement for all associates. Offers of employment are contingent on being fully vaccinated for COVID-19 or through an approved accommodation request for either a medical or religious exemption. Requests for accommodations can be made to a representative in the human resources department upon receiving an offer.
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the EEO is the Law poster.
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