Reimbursement Analyst I

Essential Duties & Responsibilities

• Completes basic projects with limited or no supervision after an initial period of training.
• Participates in mid- and higher-level projects with supervision.
• Provides peer review and QC of other Analysts work as directed.
• After a period of introduction, demonstrates an ongoing basic understanding of:
  • Insurance concepts and principles and the related regulatory environment
  • Data Warehouse and EDW layout and use
  • Computer file organization, layout, and design principles
  • The specific reimbursement issues relating to all segments of BCBSWY business
  • Healthcare providers – the types of providers and their roles in relation to healthcare in Wyoming.
  • Reimbursement methods used by BCBSWY and the related underlying principles and theory
  • Reimbursement structures on the HMHS system and how to maintain them
  • Provider structures on the HMHS system and how to utilize them
  • Claim workflow on the HMHS system
  • Claim coding standards and requirements
  • Actuary department processes, protocol, and workflow
  • Available data sources, their structure, accessibility, and limitations
• Maintains all files in such a way that:
  • Source data is included, or referenced if stored elsewhere;
  • All worksheets and calculations can be interpreted;
  • Final product is included;
  • A written summary of noteworthy circumstances particular to the current file is included; and,
  • File is accurately labeled and easily located in work area.
• Provides support and acts as a reference for other departments.
• Communicates problems and progress with projects to Supervisor and peers on a regular basis.
• Makes verbal or written reports at meetings to acquaint department personnel with status of functions and shows interest in current department activities.
• Documents all data reporting errors or data service problems and reports these to Supervisor and peers.
• Works towards quality initiatives by making ongoing improvements to all projects/systems; strives to make routine projects as efficient as possible.

Standard