Resp & Qualifications
PURPOSE:
This position will support the Pricing Administration Management department with NetworX Pricing. Implements provider pricing based on contracting, standard fee schedules, mandates and any projects and or corporate initiatives related to provider pricing. Analyzes business scope of work, determines appropriate systemic process; reporting analysis, conducting training, data validation for internal/external audits, and more.
ESSENTIAL FUNCTIONS:
- Prepares to implement provider pricing by analyzing supporting documentation and determines appropriate methodology. Conducts root cause analysis to identify efficiencies and opportunities for improvement.
- Also related to implementation of provider pricing initiatives, identifies operational requirements by analyzing requirements and business needs; determining scope; documenting results; identifying phases and elements and ensuring provider data accuracy and procedural guidelines.
- Collaborating with internal customers by frequent communication and status updates. May include conducting training; writing documentation; providing support and help.
- Develops operation problem solutions by studying system capabilities; analyzing alternative solutions; preparing functional specifications to ensure reimbursement methodologies developed meets the needs of the business.
- Review/Research operations systems by analyzing and resolving problems; reviewing system integrity and security; establishing and enforcing operation standards.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 2 years experience as a Functional Analyst OR 4 years experience in (level 2 or above) operational role.
Preferred Qualifications: 7-9 years experience in an operations role preferred.
Knowledge, Skills and Abilities (KSAs)
- Highly proficient in Microsoft Office and similar applications.
- Ability to create graphics and report to non-technical audiences.
- Self-starter and ability to collaborate in a team environment.
- Excellent communication skills both written and verbal.
Salary Range: $52,344 - $103,961
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Pricing Administration and Man
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship.
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