Pricing Reimbursement Analyst I or II

Cambia Health Solutions•Portland, OR

6d•$49,000 - $108,000•Hybrid

About The Position

Cambia is hiring a Pricing and Reimbursement Analyst I or II to join its Provider Reimbursement team. The role analyzes, develops, and maintains contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers across all regions and Regence subsidiaries. It implements and sustains accurate contract payments negotiated by Regence. This is a hybrid role, with three days per week in the office, at listed Cambia offices. Preference is given to current employees and candidates who live within commuting distance of certain offices or are willing to relocate. The position works with internal teams and external provider stakeholders to ensure accurate and timely reimbursement, investigate payment issues, and support reimbursement strategy development. The Analyst II level additionally requires direct pricing and reimbursement analyst experience and demonstrated leadership in corporate projects. The role is eligible for a 6% bonus target. Pay ranges vary by location and level. The stated expected hiring ranges are $58,700–$79,400 for Analyst I and $70,600–$95,500 for Analyst II in Oregon, Utah, and Idaho; and $52,800–$71,400 for Analyst I and $63,500–$85,900 for Analyst II in North Dakota. Cambia offers a competitive benefits package, including medical, dental, and vision coverage, paid time off, paid holidays, a 401(k) plan with company match, paid parental leave, wellness programs, and commute and parking benefits.

Requirements

Bachelor’s degree in business or a related field and at least two years of healthcare industry experience, including one year of project-related experience, or an equivalent combination of education and work experience.
At least three years of claims processing experience with knowledge of various reimbursement methods.
Ability to read, interpret, and apply provider contracts, medical and hospital pricing methodologies, and billing practices with attention to detail and accuracy.
Solid understanding of Regence plan systems and pricing logic.
Analytical ability to identify problems, develop solutions, and implement effective courses of action in a timely manner.
Ability to work independently with minimal supervision and recognize when manager involvement is needed.
Strong verbal and written communication skills to coordinate across staff levels, external agencies, and medical professionals.
Proficiency in Microsoft Office Suite, including Excel, Word, and Access, and SQL query development; ability to analyze data, identify discrepancies, and validate updates.
Ability to review and audit peer work for accuracy and completeness.
Ability to author and enhance clear, user-friendly team documentation.
For Analyst II, at least two years of direct Pricing and Reimbursement Analyst experience with demonstrated expertise.
For Analyst II, demonstrated leadership in corporate projects, including significant decision-making and active participation while working as a Pricing and Reimbursement Analyst I.

Responsibilities

Collaborate 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 programming changes are implemented correctly and on time.
Research, analyze, and implement provider reimbursement methodologies across the industry while supporting 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.
Research contract and pricing issues that may result in overpayments or underpayments, recommend corrective actions, and coordinate implementation of solutions.
Serve as a liaison with internal departments and divisions to clarify contract and billing issues involving providers, hospitals, and other contracted facilities.
Maintain computer hardware and software, recommend equipment or software purchases to support pricing schedules and methodologies, and provide documentation for end-user processing guidelines.
Participate in the local Regence Reimbursement Subcommittee and represent the Regence plan at state or regional meetings and committees.
For Analyst II, provide demonstrated leadership and significant decision-making participation in corporate projects.
Review and audit peers’ work to ensure deliverables are accurate and complete.
Author and improve team documentation that explains complex processes in clear, user-friendly materials.

Benefits

Medical, dental, and vision coverage for employees and eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Paid time off that varies by role and tenure, plus 10 company-paid holidays.
401(k) plan with company match and a potential discretionary contribution based on company performance.
Up to 12 weeks of paid parental leave, subject to eligibility requirements.
Wellness programs that reward participation.
Employee Assistance Fund.
Commute and parking benefits.
Bonus opportunities.
Employee resource groups and opportunities to participate in community outreach programs.