Reimbursement Analyst

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

This position is a key strategic partner to health network reimbursement and will be directly involved in structuring and maintaining reimbursement for institutional, professional and ambulatory surgical center networks. This position is responsible for the building and maintenance of our provider contracts and fee schedules in our claims system. Work with Provider Advocates to resolve reimbursement issues related to their contracts. Perform post payment audit and analysis on data related to billing and coding for reimbursement related polices.

What you'll do:

• Accurately construct, load, audit, maintain, and document all reimbursement schedules for the BCBSNE claims systems.

• Research and analyze claim data for inappropriate billing practices, inappropriate coding, and any other reimbursement methodology concerns. This will include investigation of APR-DRG's, CPT/HCPCS codes, Revenue Codes, ICD-10's, any potential BCBSNE auditor errors, any potential system errors, inappropriate application of benefits, or any other factors deemed necessary to appropriately adjudication claims.

• Create all documentation necessary to record any review of live claims and the resulted actions. Consult with Reimbursement department leadership to determine necessary adjustments prior to full adjudication of the live claims.

• Perform all special claim payment and special billing investigations for all claim types.

• Work collaboratively with Business Analytics, Provider Advocates, Special Investigations Unit, and other inter-department teams on a wide variety of reimbursement related projects.

• Provide assistance with any billing, coding, or provider payment concerns that arise from claim audits. Also serve as a subject matter expert regarding network reimbursement.

• Keep abreast of changes to industry standards, coding/billing guidelines, internal medical policy, benefit changes, and reimbursement methodologies.

To be considered for this position, you must have:

• Associates Degree in a related fieldand three (3)years' experience in healthcare.
• Intermediate to advanced Microsoft Office skills (Highest priority in Excel).
• Claims processing training.
• Medical Coding Experience.

The strongest candidates for this position will also possess:

• Strongunderstanding of institutional, professional and ambulatory surgery reimbursement methodologies including CPT/HCPCS, RBRVS, APR-DRG's, and EAPG's.
• Bachelor's Degree in Accounting, Healthcare or other business related field.
• Agile Training.
• Experience in SQL or other programming languages.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.