Pricing and Reimbursement Analyst I or II, DOE

Overview

This role involves working from home within Idaho, Oregon, Utah, or North Dakota as a Pricing and Reimbursement Analyst on the Provider Reimbursement team. The position focuses on analyzing, developing, and maintaining contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across various regions. The goal is to implement and sustain accurate contract payments for all provider types to support a person-focused healthcare experience.

Responsibilities

• Collaborate with Provider Services, Network Management, corporate business support, and operations staff to ensure negotiated provider and institutional payments are implemented correctly and promptly.
• Load and maintain rates in system files to accurately price professional and facility claims for contracted providers.
• Research, analyze, and implement provider reimbursement methodologies industry-wide and support the development of new reimbursement strategies.
• Create payment exhibits attached to provider contracts and maintain updates to CPT, DRG, AP-DRG, HCPCS, per diem, ICD-9, and HCPCS coding changes.
• Research contract and pricing issues that may result in over or underpayments, recommend corrective actions, and coordinate implementation of solutions.
• Serve as a liaison with internal departments and divisions to ensure understanding of contract and billing issues from providers, hospitals, and other contracted facilities.
• Maintain computer hardware and software, recommend new equipment or software purchases to support pricing schedules and methodologies, and provide documentation to support end-user processing guidelines.
• Actively participate in local reimbursement subcommittees and represent the organization at various state or regional meetings and committees.

Requirements

Pricing and Reimbursement Analyst I

• Bachelor’s degree in business or related field and at least two years of experience in the healthcare industry, including one year of project-related experience, or an equivalent combination of education and work experience.
• Minimum of three years claims processing experience with knowledge of various methods of reimbursement.

Pricing and Reimbursement Analyst II

• Bachelor’s degree in business or related field and at least two years of experience in the healthcare industry, including one year of project-related experience, or an equivalent combination of education and work experience.
• Minimum of three years claims processing experience with knowledge of various methods of reimbursement.
• At least two years of direct Pricing & Reimbursement Analyst experience with demonstrated expertise.
• Demonstrated leadership in corporate projects with significant decision-making and active participation at the Level I analyst stage.

Skills and Attributes (Both Levels)

• Ability to read, interpret, and apply provider contracts, medical/hospital pricing methodologies, and billing practices with strong attention to detail and accuracy.
• Knowledgeable pricing resource with a solid understanding of plan systems and pricing logic.
• Strong analytical skills to identify problems, develop creative solutions, and implement effective actions promptly.
• Ability to work independently with minimal supervision and recognize when manager involvement is needed.
• Strong verbal and written communication skills to coordinate activities across various staff levels, external agencies, and medical professionals.
• Ability to contribute to and lead corporate projects demonstrating maturity, tact, and diplomacy.
• Proficient in Microsoft Office Suite (Excel, Word, Access) and SQL query development.
• Ability to analyze data, identify discrepancies, and validate updates accurately and completely.
• Experience reviewing and auditing peer work to ensure accuracy and completeness.
• Ability to author and enhance team documentation, translating complex processes into clear, user-friendly materials.

Compensation

• Oregon, Utah, Idaho:

  • Pricing and Reimbursement Analyst I: Expected hiring range $27.50 - $37.50 per hour; full range $25.90 - $42.20.
  • Pricing and Reimbursement Analyst II: Expected hiring range $33.50 - $51.30 per hour; full range $31.50 - $51.30.
  • Bonus target: 5%.

• North Dakota:

  • Pricing and Reimbursement Analyst I: Expected hiring range $24.50 - $32.89 per hour; full range $21.99 - $35.19.
  • Pricing and Reimbursement Analyst II: Expected hiring range $29.00 - $39.00 per hour; full range $26.03 - $41.65.

Benefits

• Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure, plus 10 company-paid holidays.
• Market-leading retirement plan with company match on 401(k) contributions and potential discretionary contributions based on company performance (no vesting period).
• Up to 12 weeks of paid parental leave (eligibility requires 12 months of continuous service immediately preceding leave).
• Award-winning wellness programs with participation rewards.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Additional Information

• Work from home options are available; employees must have a wired internet connection (not satellite or cellular) with minimum upload speed of 5 Mbps and download speed of 10 Mbps.
• New hires must have access to a personal mobile device to set up Multi-Factor Authentication (MFA) for system access.
• The employer is an Equal Opportunity employer committed to a drug and tobacco-free workplace.
• All qualified applicants will receive consideration without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected status.
• A background check is required.
• Accommodation is available for applicants with medical conditions or disabilities during the application process upon request.

Location

Remote work within Idaho, Oregon, Utah, and North Dakota.