IDR Reimbursement Analyst

Blue Cross and Blue Shield of Kansas•Topeka, KS

16h•Hybrid

About The Position

The IDR Reimbursement Analyst is responsible for overseeing the development, implementation, and continuous improvement of reimbursement strategies specifically supporting Independent Dispute Resolution (IDR) and the development of Open Negotiation amounts under the No Surprises Act. This role ensures that IDR reimbursement analyses and negotiation support align with contractual agreements and healthcare regulations, while leading advanced financial and technical analyses and providing strategic recommendations to support accurate, defensible provider payment outcomes. The Analyst collaborates with cross-functional teams and drives process improvement, automation, and documentation across IDR reimbursement workflows. The Analyst will also be responsible for the creation of complex reimbursement and negotiation models.

Requirements

High school diploma or equivalent required.
In lieu of degree, 5 years managed care billing or pricing / financial analysis experience is required.
A minimum of five years' experience with technology administration, health care reimbursement, managed care billing and pricing, applied mathematics, financial economics, or another relevant field is required.
A deep understanding of provider reimbursement methodologies, including a minimum of 3 years of experience required.
Experience supporting dispute workflows, payment escalation, negotiation support, or regulatory reimbursement processes, required.
Strong experience with and understanding of data warehouse structures, data extraction tools, analytics software and methods, and data modeling is required.
A minimum of two (2) years of experience leading complex or cross-functional projects, including defining scope and requirements, managing timelines and dependencies, coordinating stakeholders, and delivering analytical or technical initiatives from planning through implementation required.
Expertise in financial modeling, reimbursement analysis, and trend forecasting, including models supporting Open Negotiation and IDR.
Strong understanding of healthcare reimbursement methodologies, including fee schedules, contractual terms, and payment policy interpretation.
Working knowledge of federal and state healthcare regulations impacting reimbursement and dispute resolution.
Advanced SQL proficiency with experience extracting, validating, and analyzing large claims datasets; ability to write efficient, well-documented queries and support reproducible analytics.
Strong technical skills with data analysis and reporting tools such as Excel, SQL, QMF, Tableau/Power BI (or equivalent), including experience with large datasets, claims analysis, and automated reporting.
Proven ability to lead cross-functional work, manage multiple priorities, and deliver outcomes through structured project management and stakeholder communication.
Ability to convey complex financial, regulatory, and technical concepts to a variety of stakeholders, including senior leadership, in clear and defensible terms.
Experience mentoring/coaching others and promoting documentation standards and analytical best practices (as applicable to level).

Nice To Haves

Bachelor's degree in Finance, Accounting, Mathematics, Statistics, Risk Management, Economics, Health Care or related degree, preferred.
IDR experience preferred.
No Surprises Act / IDR familiarity preferred.

Responsibilities

Lead the analysis, development, and maintenance of reimbursement methodologies supporting Open Negotiation and IDR, ensuring alignment with contractual agreements and compliance with regulatory standards.
Develop and maintain Open Negotiation amounts using claims experience, contractual terms, QPA-related inputs, external benchmarks, and internal pricing methodologies; ensure outputs are defensible and consistently documented.
Provide in-depth financial analyses on reimbursement rates, provider payment structures, claim trends, and dispute outcomes, offering insights for strategy and process improvement.
Collaborate with internal departments (Provider Relations, Claims, IT, Compliance, and Legal) and external stakeholders to support IDR case workflows, implement reimbursement models, and ensure consistent operational execution.
Lead initiatives to optimize IDR reimbursement processes, identifying opportunities to improve efficiency, reduce manual effort, strengthen auditability, and enhance internal stakeholder experience.
Act as a subject matter expert on provider reimbursement methodologies, including fee-for-service, CMS IPPS, and CMS OPPS, and how these relate to dispute resolution and negotiation support.
Oversee and conduct system testing and validation to ensure data integrity in payment/analytics systems and the accuracy of reimbursement and IDR-related outputs.
Develop, maintain, and automate reporting for IDR volume, cycle times, outcomes, financial impacts, and drivers; ensure reporting is consistent, reliable, and leadership-ready.
Lead project workstreams related to IDR and reimbursement analytics (requirements, timelines, deliverables, risks/issues, stakeholder updates).
Prepare and present comprehensive reports to senior leadership summarizing IDR trends, financial performance, negotiation drivers, and recommendations for process or policy enhancements.