Reimbursement and Incentives Analyst II

The Reimbursement and Incentives Analyst II analyzes provider reimbursement and incentive program methodologies and strategy to identify opportunities for network intervention and potential areas to reduce cost. Models and forecasts changes in reimbursement rates and methodologies and their associated financial impact to organization and assists with development of cost estimates and budget development/monitoring. Assists with communication to physicians, providers, and facilities regarding various reimbursement and incentive programs. Performs other duties as assigned.

Qualifications:

• Bachelor's degree or equivalent experience in related field
• 3+ years of work experience beyond degree (ex. 7 years of experience without a bachelor's degree required)

Skills and Abilities:

• Healthcare reimbursement and fee schedule development and implementation including uploading new fee schedules, tracking fee schedule activity, and facilitating fee schedule provider renewal impacts and coding updates preferred
• Experience working in Healthcare OR Healthcare Payer preferred
• 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
• 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

Preferred:

• Preferred SQL and SAS experience but not required

This position is an Office role, which requires an employee to work onsite at our Madison, WI office, on average, 3 days per week.

The full salary range for this position is $55,400-$95,000 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.

We are an Equal Opportunity 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.