Reimbursement and Incentives Analyst II

Medica•Madison, WI

5d•Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. 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.

Requirements

Bachelor's degree or equivalent experience in related field
3+ years of work experience beyond degree

Nice To Haves

Experience working in Healthcare OR Healthcare Payer preferred
Preferred SQL and SAS experience but not required
Knowledge with Ancillary reimbursement including: Home Health Care, Durable Medical Equipment, Home Infusion Therapy, etc.
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

Responsibilities

Documenting processes, dependencies, and tools to maintain fee schedules in Medica’s provider reimbursement payment platforms
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