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Value Based Reimbursement Analyst I

Apply now Job no: 495465
Recruiter: Allison Plummer
Hiring Manager: Dwayne Asche
Salary Grade: I-6
Work type: Regular
Location: Omaha, Nebraska, Lincoln, Nebraska, Columbus, NE, Kearney, Nebraska, Norfolk, NE, North Platte, NE, Scottsbluff, Nebraska, Nebraska
Categories: Administration

Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid – 3 days in office, Hybrid – 2 days in office, 100% remote. If choosing to work remote, this role can be located in one of the following states: Arkansas, Colorado, Florida, Indiana, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Pennsylvania, Texas, Virginia, and Wisconsin.

This position will participate in the development and coordination of innovative programs designed to transition from fee-for-service reimbursement to a system based on value (e.g., Patient Centered Medical Homes, Accountable Care Organizations, pay-for-performance initiatives, payer gain-sharing, bundled payments, etc).

The individual will provide technical and analytical support for value-based reimbursement programs, including independently analyzing, and monitoring/measuring the performance of the initiatives by leveraging utilization, financial, clinical, and benchmark data from multiple internal and external sources. Will perform analysis, summarize results, and oversee value-based payments while adhering to established standards and processes.

What you'll do:

  • Works as the subject matter expert for value-based projects. Participates in projects to ensure the strategic directives of the stakeholders are executed and time sensitive deadlines met.
  • Provides analytical support for value-based programs, including independently monitoring/measuring the performance of the initiatives by leveraging utilization, financial, clinical, and benchmark data from multiple internal and external sources.
  • Will perform analysis, summarize results, and oversee value-based payments while adhering to established standards and processes.
  • Monitor and research health care and health industry developments on best practices and initiatives in developing new provider payment and network models to support more coordinated, efficient and quality-driven healthcare.
  • Provides expertise in analysis of data related to supporting value-based programs.  Skills include accessing internal databases and tables as well as utilizing advanced Excel skills.  Additionally, utilizes vendor resources, data and dashboards to independently investigate issues, provide information for future programming and resolve provider inquiries.

This position requires a minimum of 15 %  travel per month

To be considered for this position, you must have:

  • Bachelors Degree in related field and two (2) years  experience in the health industry. An equivalent combination of education and experience may be substituted to meet this requirement.
  • The ability to meet or exceed the attendance and timeliness requirements of their departments.
  • The ability to work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.

The strongest candidates for this position will also possess:

  • Masters Degree
  • Six(6) months experience with Patient Centered Medical Homes and/or Accountable Care Organizations
  • Provider contracting and/or reimbursement program implementation experience
  • Experience in independently managing relationships with provider groups, including ACOs or PCMHs
  • Knowledge of Agile processes

Blue Cross and Blue Shield of Nebraska (BCBSNE), as a federal contractor in our administration of the Federal Employee Program (FEP) and the Medicare Advantage (MA) Program, is required to comply with the government’s mandate that all federal contractors and subcontractors be vaccinated against COVID-19.  Accordingly, BCBSNE will be required to provide documented proof of vaccination against COVID-19, with exemptions for disability or religious reasons, for all of its employees if the decision is made by the Supreme Court to uphold the mandate.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans

 

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