Provider Reimbursement I

The Reimbursement Analyst will be responsible for supporting both the fee schedule development and implementation processes for the Fee Schedule Management team. The analyst will work to document processes, dependencies, and tools to maintain Medica’s provider fee schedules and work with stakeholders on identifying refinement opportunities. Additionally, the analyst will be responsible for supporting contract model data inputs, stewardship of provider finance data, and working with stakeholders to identify opportunities to improve model functionality, efficiency, and accuracy.

The analyst will assist in the successful operation of the Fee Schedule Management team. This individual ensures that processes and policies are followed to produce high quality results. The analyst proactively engages on identified opportunities and facilitates solutions with various stakeholders.

In the intermediate role, the analyst has basic knowledge and skills with claims adjudication, contract administration, financial modeling, and Medicare/Medicaid & Ancillary reimbursement methodologies, but in most cases a fair amount of initial training from senior staff is required. Advancement is recognized for individuals who demonstrate accomplishments in analytical capabilities, development in the knowledge base of their focus, and decreased need for guidance and direction for completing projects. Additionally, exceeding expectations regarding day-to-day as well as major projects is also typical for advancement as well as demonstration of leadership skills.

Qualifications:

• Bachelor's degree or equivalent combination of education and experience

Key Responsibilities:

• Fee schedule development and implementation including uploading new fee schedules, tracking fee schedule activity, and facilitating fee schedule provider renewal impacts and coding updates.
• Documenting processes, dependencies, and tools to maintain fee schedules in Medica’s Provider Reimbursement payment platforms.
• Knowledge with Ancillary Reimbursement Including: Home Health Care, Durable Medical Equipment, Home Infusion Therapy, etc.
• Support provider contract modeling solutions and contract modeling inputs.

• Work together with key stakeholders to optimize Medica’s provider negotiation model process through the promotion of refinements to improve model functionality, efficiency, and accuracy.

• Promotes and participates in efforts focused on data stewardship and best practices.

• Provide support to expansion growth on the Medicare/Medicaid initiatives as a subject matter expert. This may include locality based payments, regulatory pricing and reimbursement changes, and development of fee schedules from CMS resources.
• Interacts heavily with team members and other departments. Builds strong relationships with groups across the organization, including: Network Management, Provider Network Operations, and IT.
• Provides support to network management strategic initiatives.
• Assists with other provider finance activities such as supporting Medical Expense Committee, Reimbursement Committee, & commercial RFP.

Preferred:

• Preferred SQL and SAS experience but not required

This position is a Hub role, which requires an employee to occasionally come onsite to the designated office, Minnetonka, for applicable heads-up work. Frequency is determined by business need as decided by leadership.

The full salary range for this position is $48,600 - $83,300. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)