The posting
Company Description
Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
Learn more about our unique benefit offerings here.
Job Description
About the role: Also known internally as a Sr Network Economics Analyst, you will lead, design, implement and maintain provider reimbursement strategies, including financial reporting for all Wellmark-contracted providers as well as multi-year agreements. This includes leading provider reimbursement initiatives by applying your thorough understanding of contracting, claims payment procedures and payment policy. Collaboration is key, so building and maintaining strong business relationships with other Health Network team members at Wellmark will be important to enhance the support we deliver to our providers. As a Senior-level team member, you will mentor team members and serve as the subject matter expert on the team, as well as be responsible for making recommendations to leadership on strategic and payment policy decisions.
About you: You are a critical and strategic thinker, detail-oriented and analytical to your core. You are skilled at thinking conceptually, anticipating long-term outcomes, and identifying and implementing continuous improvement opportunities around provider reimbursement. You enjoy using your advanced data analysis experience and consultative nature to make recommendations and partner with internal business leaders. You are skilled in creating and communicating insights from data to help “tell the story." In addition, you enjoy educating and mentoring peers to help build their analytical skills and strategic provider reimbursement knowledge.
Hospital and/or health care facility reimbursement experience preferred. Candidates currently residing in the Des Moines, IA metro area preferred.
This position will work a hybrid schedule of at least 3 days in Wellmark's Des Moines office (Tuesday-Thursday), with Monday & Friday remote option.
Internal Job Title: Sr Network Economics Analyst
Qualifications
Required Qualifications:
- Bachelor's degree in accounting, finance, business, economics or related field or direct and applicable work experience.
- 7+ years of relatable experience within the health insurance, healthcare or related financial industry experience including demonstrated experience performing financial analysis and data modeling preferably in a healthcare setting.
- Solid knowledge of and demonstrated ability in Microsoft Excel along with technical proficiency with tools such as Power BI, Tableau, SAS EG and/or SQL.
- Knowledge of hospital, physician and other provider payment and contracting strategies.
- Demonstrated knowledge of the health insurance industry including delivery systems and managed care concepts; thorough understanding of reimbursement, contracting, claims processing, medical policies.
- Experience interpreting claims data, trends and provider utilization in order to determine payment strategy or payment strategy results.
- Demonstrated forethought of issues before questioned; ability to research, ask questions and find solutions to potential problems.
- Demonstrated problem-solving, quantitative and analytical skills; ability to recognize inconsistencies, analyze for reasonableness and accuracy, research and come to conclusions.
- Comprehensive knowledge of nationally recognized provider compensation strategies.
- Strong attention to detail (timeframes, resources, parties involved, communication, etc.) in developing and implementing action plans.
- Demonstrated ability applying strong analytical, conceptual and strategic thinking skills to negotiate with providers, or the organizations representing them.
- Ability to serve as subject matter expert to mentor team members.
- Strong presentation skills and the ability to clearly articulate recommendations to business leadership to achieve business results.
- Proficiency in HROR highly preferred.
Additional Information
What you will do:
a. Lead, design, implement and maintain provider reimbursement strategies, including financial reporting for all providers. Research, document, monitor and implement provider reimbursement related activity and initiatives.
b. Perform advanced data analysis and insight in support provider reimbursement initiatives. Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations as appropriate.
c. Consultant with and provide subject matter expertise to Network Economics, Health Network and other Wellmark business stakeholders in the recommendations and enhancements to provider payment strategies and payment policy decisions.
d. Serve as consultant in collaboration with Network Engagement to provide reimbursement guidance/expertise and payment policies to providers and applicable stakeholders.
e. Configure, transfer and monitor data that is being processed in the provider payment systems. Collaborate with testing and system implementations and enhancements. Provide business knowledge and payment processing expertise in projects, if applicable.
f. Collaborate, interface and manage all service level agreements and management of the relationship with all provider payment vendors.
g. Other duties as assigned.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]
Please inform us if you meet the definition of a "Covered DoD official".
At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants
Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.
