At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, gender identity or expression.
Analyze, support and monitor contractual arrangements between Blue Cross and participating providers, and provide data and reimbursement analysis and recommendations to management on issues impacting reimbursement. Resolve payment rates, complete special projects, develop the physician fee schedule and analyze hospital reports, including financial analyses. Review and analyze physician and ancillary proposals ranging from fee for service to risk-sharing arrangements.
REPRESENTATIVE JOB DUTIES
Develop positions and alternatives for hospital, ancillary and physician contracts, attend internal negotiation sessions, suggest strategy, maintain technical backup. Utilize creativity in developing alternate approaches for contracts, providing technical and analytical support for senior management and the negotiating team.
Monitors national reimbursement trends through analysis of publications, contacting other BC Plans, etc. Plays a key role in supporting corporate goals and objectives, such as negotiating favorable contracts for all Blue Cross product lines. Calculate the financial impact of Blue Cross and provider positions, and determine the impact on corporate forecasts and rating.
Perform special projects for Director, VP Contracting, other Sr Management and other departments. Some projects are on-going, while others are one-time only. This would include representing the department on corporate committees and implementing and monitoring key corporate initiatives.
Coordinate new reimbursement methodologies with Claims and Systems personnel. Coordinate loading of new pricing for hospitals, physicians and other providers on the system. Develop and maintain contract matrices, hospital profile reports and other reports for use by Contract Administrators and Senior Management.
Price unpriced codes for fixed fee hospitals, physicians and ancillary providers. Also includes yearly adjustments of pricing due to CPT code changes and maintenance of physician profiles, including negotiated agreements.
KNOWLEDGE, SKILLS & ABILITIES REQUIRED:
Health care provider contracting and statistical analysis.
Microsoft Office skills.
Ability to extract data thru programming or database software, SAS.
Strong interpersonal and communication skills.
Strong decision making skills.
Strong persuasive skills required to negotiate, develop, influence, motivate, and change the behavior of others.
Non-Technical Skills and Behaviors :
Seeks out different points of view to come up with the best solution.
Applies expertise to get results.
Delivers high quality service to customers.
Changes work activities based on business needs and deadlines.
Finds “root cause” of problem to identify an effective solution.
Finds needed information in a timely manner.
Monitors and communicates progress toward meeting goals.
Deal with high-level financial personnel at providers, including CFO’s and CPA’s.
Handle multiple priorities through project management
Exercise sound judgment.
Take initiative in finding solutions to difficult and/or sensitive problems.
Perform other duties as assigned.
Minimum Education and Experience:
Bachelor's Degree in Business, Math, Statistics or related field or an equivalent combination of education and work experience.
Experience in PC usage, including strong working knowledge of Microsoft Office.
One year of experience in health care provider contracting and statistical analysis.
Preferred Education, Additional Qualifications and Experience:
Advanced Degree in one of the above areas a plus.
Knowledge of BCBSRI systems.
Knowledge and/or experience in computer programming and Microsoft Access a plus.
Reimbursement background a plus.
Blue Cross Blue Shield of Rhode Island - 2 years ago