NetworX Provider Reimbursement and Content Analyst

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

Job Description

Summary: The Provider Reimbursement and Content Analyst formulates and defines systems scope and objectives; and combines an understanding of applicable business systems and industry requirements. Must possess an understanding of the provider reimbursement business functions/processes supported, and be viewed as a knowledgeable representative of that business function/process. Serves in the relationship interface between IT, Operations, and the business; understanding contract and benefits language, specific technical NetworX configuration terms, and perform queries for claim impacts/provider identification/product networks. This role performs with minimal supervision.

Job Description

• Perform analysis and content review for contract updates and provider reimbursement applications that are core to the BlueKC business.
• Communicates with team leads, management, IT, and business leadership to drive the coordination of processes across the enterprise.
• Validates the quality of work performed by performing QA on all configuration changes.
• Participates in the development of best practice NetworX configuration for complex contracting and negotiations for multiple provider payment methods.
• Contributes to the development of As-Is and To-Be process flows.
• Creates and runs test cases that are planned and executed. Participates in root cause analysis of defects found during testing.
• Performs feasibility analysis based on an understanding of proposed methodologies.
• Identifies solutions of production issues based on an in depth understand of systems and systems functionality.
• Communicates business information, technical information and developments to users and technical staff in both verbal and written form; provides or coordinates feedback to management and/or users on all open issues.
• Performs other related duties as assigned.

Minimum Qualifications

• Bachelor’s degree from an accredited university or college in Healthcare Administration, Business, Information Systems or a related academic field; or an equivalent combination of education and experience
• 4 years - Demonstrated experience with payment methodologies, and network management experience for various provider types, specifically in NetworX
• 3 years of experience interpreting complex contract language and intent specific to provider reimbursement
• 2 years extensive knowledge claims processing / billing
• Working knowledge of medical terminology, code updates, data warehousing, operational systems, internet application concepts
• Intermediate knowledge and skill using SQL and Microsoft Access
• Intermediate experience using Microsoft Office Suite

Preferred Qualifications

• Experience with Healthcare concepts; Blue experience preferred
• Experience with preparing technical and configuration documentation

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability. Apply tot his job Apply To this Job