Reimbursement Policy Analyst

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

The incumbent is responsible for ensuring reimbursement policies, including any medical coding they might contain, are implemented, and integrated in all systems for accurate claims adjudication. This role will provide process and project management, as well as implementation support.

A Day in the Life:

• Manage the operational components of the Reimbursement Policy decision making committees that lead up to reimbursement policy approval (i.e. Reimbursement Policy Work Group, Reimbursement Policy Team Meetings and prep meetings leading up to formal committees)-including meeting coordination, issues management, agendas, minutes, follow-up, etc.
• Presentation of assigned policies and discussion topics at Reimbursement Work Group and Reimbursement Committee, as well as other formal meetings, in a clear and articulate manner that enables efficient, on point discussion and appropriate actions being taken as a result.
• Designs and maintains spreadsheets and documents, databases and other systems for record keeping, project tracking and reporting to meet management requirements.
• Monitor and track Reimbursement Policy BEM questions/inquiries from organizational partners.
• Coordinates and performs special projects and assignments within specific time frames.
• Preparation and posting of new/revised policies, including coordination of internal and external communication.
• Assist in maintaining policy tracking and status during implementation.
• Assist with policy database updates and changes.
• Team project management support as needed.
• Serve as a liaison to other divisions/departments (Health Management, Service, Claims) for Reimbursement Policy.
• Participate as a team member of cross-departmental committees (e.g. BCAG, etc).

Nice to Have:

• Bachelor’s Degree in business or related field.
• Knowledge of medical terminology, and/or coding certification.
• 3 years of experience in a health care setting.

Required Skills and Experiences:

• Associate degree in business, health care or related field or 2 years of related experience in lieu of a degree.
• Strong PC skills; Excel, Word, PowerPoint and internet-based programs.
• Proficiency in conducting research
• Experience in claims
• Ability to manage key details and keep areas of accountability organized.
• Strong interpersonal, written, and verbal communication skills including presentation skills.
• Project management experience.
• Ability to apply critical thinking skills to Reimbursement Policy interpretation and implementation.

Role Designation:

Teleworker

Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected].

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.