PacificSource Hiring for Provider Reimbursement Analyst – 2023-1488-2367 at Boise, Idaho Full Time

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please see: https://idahoworks.gov/jobs/2083130 Looking for a way to
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Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified
applicants will receive consideration for employment without regard to
status as a protected veteran or a qualified individual with a
disability, or other protected status, such as race, religion, color,
national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the
people we hire and serve. We are committed to creating a diverse
environment and fostering a workplace in which individual differences
are appreciated, respected and responded to in ways that fully develop
and utilize each person’s talents and strengths.

Position Overview: Provides a wide range of support to Provider
Network, Facets Business Support, Claims, Finance and Analytics in
coding, hospital charge master tracking and evaluation, reimbursement
methodology research, loading and documentation for all lines of
business. Responsible for all regular and off-schedule fee schedule
preparation and documentation, including Federal Registers, CMS, DRGs,
ASC, ASP, Lab, DMAP, ASA, Essentials RBRVS and PacificSource default fee
schedules.

Essential Responsibilities:

• Research, initiate and audit updates of published fee schedules for
  commercial and government lines of business.
• Research requests from internal and external customers on
  establishing fee allowances as appropriate for otherwise
  undetermined allowables and present recommendations to the Director
  or VP of Provider Network.
• Perform regular reconciliation and administration payment processes
  for facilities, IPAs, provider groups and panels, and coordinate
  payments with Finance.
• Collaborate with Analytics on analyses projects, including, but not
  limited to, COB, contract renewals and initial negotiations and
  reimbursement trends.
• Collaborate with provider contracting staff on opportunities for
  improved contracting due to contract aging, non-competitive rate
  positions or methods, and the results of charge master analysis.
• Communicate updates and trends to internal stakeholders.
• Responsible for invoice preparation, documentation and audit of
  provider network fees and capitation payments, as specified in
  agreements with provider groups, IPAs, provider panels and capitated
  entities.
• Work with Compliance Audit and Reporting Specialists to ensure
  post-claims audits are accurate, timely and consistent with
  PacificSource policies and procedures.
• Educate and train staff in reimbursement methodologies, payment
  policies and contract compliance.
• Develop policies and procedures related to duties.

Supporting Responsibilities:

• Participate in department training and meetings as needed to become
  cross-trained and proficient in other areas of the department.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and
  regulations concerning confidentiality and security of protected
  health information.
• Perform other duties as assigned.

Work Experience: Four years’ experience in health insurance.
Experience in Claims preferred.

Education, Certificates, Licenses: High School Education or
equivalent required.

Language skills: Excellent written and oral communication, including
diplomacy skills for working with the medical professional community as
well as the members enrolled in a PacificSource plan. Ability to
effectively explain administrative and claims procedures to provider
office staff of varying educational backgrounds and familiarity with
insurance billing.

Mathematical Skills: Intermediate math skills required, including
percentages, ratios, graphing and spreadsheet skills.

Knowledge: Ability to critically review and interpret complex
materials and make recommendations. Understanding of contractual
language needed. Excellent written/oral communication skills required.
Must be detail oriented, able to read financial statements, and
understand basic accounting. Experience required in Word, Excel, Access
and Publisher. Must have demonstrated ability to work independently and
as a member of a team. Ability to initiate and successfully conclude
projects by specified timeframes with minimal supervision is required.
Knowledge of reimbursement methodologies and experience using
spreadsheets to develop reports required.

Environment: Work inside in a general office setting with
ergonomically configured equipment. Travel is required approximately 5%
of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these
seven core values which guide us in how we do business:

We are committed to doing the right thing.

We are one team working toward a common goal.

We are each responsible for cus