Provider Reimbursement Analyst I
Posted on: September 17, 2022
Looking for a way to make an impact and help people? 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
- 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
- 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
- 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
- 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
- Participate in department training and meetings as needed to
become cross-trained and proficient in other areas of the
- Meet department and company performance and attendance
regulations concerning confidentiality and security of protected
- 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 customer service.
- We practice open communication at all levels of the company to
foster individual, team and company growth.
- We actively participate in efforts to improve our many
communities-internally and externally.
- We actively work to advance social justice, equity, diversity
and inclusion in our workplace, the healthcare system and
- We encourage creativity, innovation, and the pursuit of
excellence. Physical Requirements: Stoop and bend. Sit and/or stand
for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light
lifting and carrying of files and business materials. Ability to
read and comprehend both written and spoken English. Communicate
clearly and effectively. Disclaimer: This indicates the general
nature and level of work performed by employees within this
position and is subject to change. It is not designed to contain or
be interpreted as a comprehensive list of all duties,
responsibilities, and qualifications required of employees assigned
to this position. Employment remains AT-WILL at all times. This
employer is a corporate member of
myGwork - LGBTQ+ professionals, the business community for LGBTQ+
students, inclusive employers & anyone who believes in workplace
Keywords: myGwork, Bend , Provider Reimbursement Analyst I, Accounting, Auditing , Bend, Oregon
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