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Cambia Health Solutions Pricing Reimbursement Analyst I or II (DOE) in Seattle, Washington

Pricing Reimbursement Analyst I or II (DOE)Telecommute Option - Must reside in ID, OR, UT or WAWHO WE NEEDPricing Reimbursement Analyst analyzes and implements contract payment terms and rates for all provider types, for all regions and subsidiaries. Pricing Reimbursement Analyst I is responsible for the analysis, development, and maintenance of contract payments for all institutional, facility, and professional healthcare providers negotiated by Regence.Preferred Key Experience:Excel (Mid - Advanced) / Pivot TablesProvider ContractsFacets / TOAD / QueriesClaims Pricing/Medicare Pricing or ReimbursementeVips / PIMS / NetworkXpricerClaims or Audit experienceYOUR ROLE* Works closely with the Regence plans corporate business support Provider Services staff, and operations staff to ensure that negotiated payments for providers and institutions are implemented correctly and promptly.* Responsible for loading and maintenance of rates into appropriate system files to correctly price professional and facility claims for contracted providers.* Responsible for ensuring all programming changes for pricing and reimbursement are implemented correctly.* Research, analyze, and implement provider reimbursement methodologies industry-wide and support the development of new reimbursement strategies.* Maintain computer hardware and software and recommend purchase of new equipment/software packages to support pricing schedules and methodologies.* Responsible for the creation of all payment exhibits attached to provider contracts.* Serves as a liaison with the internal departments and divisions to ensure understanding of contract and billing issues from providers, hospitals and other contracted facilities.* Responsible for updating and maintaining CPT, DRG, AP-DRG, HCPCS, per diem and ICD-9 software and coding changes and ensuring all programming changes for this pricing are implemented timely and correctly.* Responsible for providing documentation to support end user processing guidelines.* Research contract and/or pricing issues, which may result in over or underpayments to physicians or facilities; make recommendations on correction of issues. Once course of action determined, responsible for coordination & implementation of those changes.* Serve as active participant on the local Regence plans Reimbursement Subcommittee. Also represents the Regence plan at various State or Regional meetings/committees.WHAT YOU BRING* 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.* Ability to maintain significant involvement in corporate projects, assuming a leadership role as necessary.* Ability to read and interpret provider contacts and understand medical and hospital pricing methodologies and billing practices.* Demonstrated ability to complete highly detailed tasks with accuracy in a timely manner. Strong attention to detail is required.* Demonstrated ability to work independently with minimal supervision and ability to determine when manager approval or involvement is required.* Good understanding of the applicable Regence plans system(s) pricing logic. The Level I person is characterized as a knowledgeable resource on pricing.* Demonstrated ability to coordinate activities with varying levels of staff, with external agencies and medical professionals through strong verbal and written communicat

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