Reimbursement and Incentives Analyst II

Description

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.

Key Accountabilities

• 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

Required Qualifications

Preferred Qualifications

This position is an Office role, which requires an employee to work onsite at our Madison, WI office, on average, 3 days per week.

The full salary grade for this position is $55,400 - $95,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $55,400 - $83,160. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and / or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.