Pricing and Reimbursement Analyst I or II, DOE

Cambia Health Solutions • Salt Lake, UT

6d • Remote

About The Position

Every day, Cambia’s dedicated team of Pricing and Reimbursement Analysts are living our mission to make health care easier and lives better. As a member of the Provider Reimbursement team, our Pricing and Reimbursement Analysts analyze, develop, and maintain contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across all regions and Regence subsidiaries. This role is responsible for implementing and sustaining accurate contract payments negotiated by Regence for all provider types – all in service of creating a person-focused health care experience. Do you have a passion for analyzing complex data and translating it into meaningful contract solutions? Do you thrive in a detail-oriented environment where accuracy and collaboration drive impactful results in healthcare reimbursement? Then this role may be the perfect fit.

Requirements

• Bachelor’s degree in business or related field and at least two years experience in the health care industry, with one year of project related experience, or the equivalent combination of education and work experience.
• Minimum of three years claims processing experience with knowledge of various methods of reimbursement.
• Ability to read, interpret, and provider contracts, medical/hospital pricing methodologies, and billing practices with strong attention to detail and accuracy
• Serves as a knowledgeable pricing resource with a solid understanding of Regence plan systems and pricing logic
• Demonstrated analytical ability to identify problems, develop creative solutions, and implement effective courses of action in a timely manner
• Ability to work independently with minimal supervision while recognizing when manager involvement is
• Strong verbal and written communication skills to coordinate activities across varying staff levels, external agencies, and medical professionals
• Ability to contribute to and lead corporate projects as needed, demonstrating maturity, tact, and diplomacy
• Proficient in Microsoft Office Suite (Excel, Word, and Access) and SQL query development, with a strong ability to analyze data, identify discrepancies, and validate that updates have been applied accurately and completely.
• Demonstrated ability to review and audit the work of peers, ensuring all deliverables meet accuracy and completeness requirements before finalization.
• Demonstrated ability to author and enhance team documentation, translating complex processes into clear, user-friendly materials that support day-to-day operations.

Nice To Haves

• Level II position requires at least two years of direct Pricing & Reimbursement Analyst experience, with demonstrated expertise in this area.
• Level II requires demonstrated leadership in corporate projects, with significant decision making and active participation while a Pricing & Reimbursement Analyst Level I.

Responsibilities

• Collaborate closely with Provider Services, Network Management, corporate business support, operations staff and others to ensure negotiated provider and institutional payments are implemented correctly and promptly
• Load and maintain rates in appropriate system files to accurately price professional and facility claims for contracted providers, ensuring all programming changes are implemented correctly and timely
• Research, analyze, and implement provider reimbursement methodologies industry-wide while supporting the development of new reimbursement strategies
• Responsible for creating all payment exhibits attached to provider contracts and maintaining 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 the local Regence Reimbursement Subcommittee and represent the Regence plan at various state or regional meetings and committees

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level