Job Opportunities API

Pricing and Reimbursement Analyst I or II, DOE Work from home within Idah, Oregon, Utah and North Dakota Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: 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. What You Bring to Cambia: Qualifications: Pricing and Reimbursement Analyst I • 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. Pricing and Reimbursement Analyst II • 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. Additional skills and Attributes for the Pricing and Reimbursement Analyst II: • 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. Skills and Attributes: • Ability   to   read,   interpret,   and   apply   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   required • 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. Additional skills and Attributes for the Pricing and Reimbursement Analyst II: • 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. What You Will Do at Cambia: • 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 • Oregon, Utah, and Idaho: The expected hiring range for the Pricing and Reimbursement Analyst I is $57,800 - $78,200, the full range is $54,000 - 89,000 and the bonus target for this role is 5%. The expected hiring range for the Pricing and Reimbursement Analyst II is $69,700 - $94,300 and the full range is $65,000 - $107,000. The bonus target for this role is 10% . • North Dakota: The expected hiring range for the Pricing and Reimbursement Analyst I is $24.50 - $32.89 the full salary range is $21.99 - $35.19. The expected hiring range for the Pricing and Reimbursement Analyst II is $29.00 - $39.00 and the full range is $26.03 - $41.65. #LI-remote About Cambia Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through. Why Join the Cambia Team? At Cambia, you can: • Work alongside diverse teams building cutting-edge solutions to transform health care. • Earn a competitive salary and enjoy generous benefits while doing work that changes lives. • Grow your career with a company committed to helping you succeed. • Give back to your community by participating in Cambia-supported outreach programs. • Connect with colleagues who share similar interests and backgrounds through our employee resource groups. We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more. In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: • 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. Learn more about our benefits . We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb. As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees. We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required. If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected] . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .