Blue Cross and Blue Shield of Illinois, Montana, N Sr. Reimbursement Financial Analyst / Healthcare in Richardson, Texas


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This position is responsible for system pricing development; support functions needed for contract financial analysis and performance; coordination of internal/external audit requests; performing routine and ad hoc reporting; and maintaining an understanding of provider contracts.


Review all non-standard contracts for system capability. Provide responses to requestor and multi-divisional Non Standard Contract Review Group (NSCRG). Participate in meetings as needed.Develop specifications for new functionality as needed to support contract provisions required to facilitate financial goals using the Agile Delivery Methodology.Participate in and coordinate all system pricing related testing. This includes: development of test plans, review of internal HCE testing, SSD/FSU testing and customer (HCM) testing results, and /providing final documentation for final HCE sign off.Support proposed contract analysis (modeling) using Premier Automated Contract Evaluation Service (ACES). Including, develop of contract provisions, error report evaluation, and interpretation of positive results.Coordinate the setup and maintenance of files and reports sent to providers. Communicates directly with Network staff and perform in-depth research and analysis to answer pricing and capitation inquiries.Documents pricing results, cap cycles, and issues. Monitors system reports for anomalies, research and provider recommendations for corrective action.Support monitoring of contract performance using ACES. Includes maintaining contract periods, mappings of ICD-9, CPT and HCPCS codes, error report evaluation and interpretation of positive results.Knowledge of all contracts and their systematic implementations. Effectively communicate business and technical aspects of system pricing with all levels of staff and management.*Represents HCE in all internal and external audits. Including SOC-1 and Quarterly MAR audits. Provide documentation for these audits are requested.


  • Bachelor’s Degree in Finance, Accounting or Math with 6 years’ experience in the Health Care Industry OR 8 years of claims, provider contracting, auditing or internal pricing.* 6 years’ experience in interpreting provider contracts and system requirements.* 6 years’ experience in a managed care healthcare environment.* 5 years’ experience in one or more of the following or similar claims adjudication and pricing systems: PREMIER Pricer, PREMIER Provider or Blue Chip* Knowledge of ICD 9 and ICD 10, Revenue code and/or DRG coding practices; mainframe and windows based applications .* Flexibility to meet deadlines in an environment of constantly changing priorities and workloads.* Leadership, analytical, problem-solving, organizational and communication skills.* PC proficiency to include Microsoft Access, Word and Excel.

Location: TX - Richardson

Activation Date: Tuesday, October 18, 2016

Expiration Date: Friday, November 25, 2016

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