Pricing and Reimbursement Analyst I or II, DOE

Overview

This remote position is open to candidates residing in Idaho, Oregon, Utah, and North Dakota. The role involves analyzing, developing, and maintaining contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across multiple regions. The Pricing and Reimbursement Analyst ensures accurate implementation and sustainability of negotiated contract payments for all provider types.

Responsibilities

• Collaborate with Provider Services, Network Management, corporate business support, and operations staff to ensure correct and timely implementation of negotiated provider and institutional payments.
• Load and maintain rates in system files to accurately price professional and facility claims for contracted providers.
• Research, analyze, and implement provider reimbursement methodologies 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.
• Investigate contract and pricing issues that may cause overpayments or underpayments, recommend corrective actions, and coordinate solution implementation.
• Serve as a liaison with internal departments to address contract and billing issues from providers, hospitals, and other contracted facilities.
• Maintain computer hardware and software related to pricing schedules and methodologies; recommend new equipment or software purchases.
• Provide documentation to support end-user processing guidelines.
• 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, plus at least two years of healthcare industry experience with one year of project-related experience, or equivalent combination of education and work experience.
• Minimum of three years claims processing experience with knowledge of various reimbursement methods.

Pricing and Reimbursement Analyst II

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

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.
• 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 managerial involvement is needed.
• Strong verbal and written communication skills to coordinate across various staff levels, external agencies, and medical professionals.
• Ability to contribute to and lead corporate projects with maturity, tact, and diplomacy.
• Proficiency in Microsoft Office Suite (Excel, Word, Access) and SQL query development.
• Ability to analyze data, identify discrepancies, and validate updates accurately.
• 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 without vesting period.
• Up to 12 weeks of paid parental leave (eligibility requires 12 months of continuous service immediately preceding leave).
• Wellness programs with participation rewards.
• Employee Assistance Fund.
• Commute and parking benefits.

Additional Information

• This role supports work-from-home arrangements requiring a wired internet connection (no 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 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 available for residents of Idaho, Oregon, Utah, and North Dakota.