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Network Economics Analyst (Financial Analyst - Provider Reimbursement)

Wellmark, Inc.

Network Economics Analyst (Financial Analyst - Provider Reimbursement)

Des Moines, IA
Full Time
Paid
  • Responsibilities

    Job Description

    USE YOUR STRENGTHS AS NETWORK ECONOMICS ANALYST:

    In this role, you will design, implement and maintain provider compensation strategies, including financial reporting for all providers with whom Wellmark may contract with. This includes supporting provider compensation initiatives by applying a thorough understanding of contracting, claims payment procedures and payment policy. You will also maintain a strong business and advocacy relationship with Network Engagement and Health Networks to enhance the support of providers.

    Ideal candidates are excellent critical thinkers and analytical at their core. They are skilled at thinking conceptually, anticipating long-term outcomes, and identifying and implementing continuous improvement opportunities. They enjoy supporting stakeholders with ad hoc requests and tackling data-related projects because it allows them to use their expertise while thinking creatively. TOP CANDIDATES WILL HAVE HOSPITAL REIMBURSEMENT PAYMENT EXPERIENCE, AS WELL AS EXPERIENCE WITH FACETS. If this sounds like you and you’re ready to help make health care better, apply today!

  • Qualifications

    Qualifications

    REQUIRED:

    • Bachelor's Degree or direct and applicable work experience.
    • 4+ years of health care, health insurance, or related industry experience:
      • In a related analytical role – e.g., provider payment/ reimbursement, provider compensation, finance, etc.
      • Demonstrates ability to anticipate and analyze long-term reimbursement model outcomes
    • Excellent critical thinking and creative problem solving skills. Uses data to inform decisions.
    • Strong conceptual, strategic thinking skills.
    • Identifies and implements continuous improvement opportunities.
    • Strong verbal/written communications skills. Articulates complex technical information effectively.
    • Effectively builds relationships, influences, and solicits cooperation from others.
    • Proactive self-starter with strong organizational, prioritization and time management skills, as well as excellent attention to detail.
    • Proficient with Microsoft Office, including Excel. Able to run queries and develop ad hoc reports.

     

    PREFERRED:

    • Bachelor’s Degree.
    • Knowledge of Wellmark and/or national recognized provider compensation strategies.
    • Understanding of Wellmark products, policies and processes to ensure consistency in the compensation strategies designed and implemented.
    • Claims processing knowledge.
    • Business Objects experience.

    Additional Information

    a. Support provider reimbursement initiatives by reviewing and calculating fee schedules paid to health care providers. Research, document, monitor and implement provider reimbursement related activity and initiatives, including financial reporting and comprehensive data analysis. b. Perform routine financial analysis for Wellmark leadership to monitor reimbursement methodologies for effectiveness. Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations as appropriate. Perform data modeling to assist provider’s understanding of methodology changes/updates. c. Develop and maintain positive professional relationships with Network Engagement and Health Network to provide proactive communication of changes. Provide timely response to provider inquiries via Network Engagement and support data needs and inquiries. May communicate and attend provider meetings, if applicable. d. Serve as consultant in collaboration with Network Engagement to provide compensation guidance/expertise and payment policies to providers and applicable stakeholders. e. Configure, transfer and monitor data that is being processed in the provider payment systems. Collaborate with testing and system implementations and enhancements. Provide business knowledge and payment processing expertise in projects, if applicable. f. Other duties as assigned.

     

    HYBRID WORK ENVIRONMENT: As a hybrid employee, you’ll spend at least three (3) days a week in the office: Tuesday, Wednesday and Thursday, with the opportunity to work remotely on Monday and Friday if desired. 

    AN EQUAL OPPORTUNITY EMPLOYER

    The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

    Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com