The Network Reimbursement Specialist is responsible for the implementation, coordination and maintenance of all routine provider reimbursement updates, including updates to professional and allied fee schedules, updates to facility reimbursement rates, pricing rule changes, and the development, execution and completion of test plans and related claims testing when implementing new or modifying existing reimbursement functionality. The Network Reimbursement Specialist is required to be (or become) the subject matter expert in Network reimbursement as it pertains to the functionality within the medical claims processing system. This position also serves as a technical consultant for medical claim reimbursement related inquiries received from other departments or external sources.
Job-Specific Requirements:
- Bachelor’s degree required.
- Logical thought process in order to interpret and apply contract benefits.
- Ability to work with a high degree of accuracy and attention to detail to ensure work products are of high quality
- Good analytical skills and proven ability to independently research, document and present solutions to problems
- Strong documentation and organizational skills required
- Strong interpersonal, communication and facilitation skills required
- Ability to multi-task and handle concurrent projects
- Knowledge of Microsoft Excel and Word is required
Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.
Skills Required
- Bachelor's degree
- Subject-matter expertise in network reimbursement and medical claims processing systems (or willingness to become SME)
- Ability to interpret and apply contract benefits using logical thought process
- High degree of accuracy and attention to detail
- Strong analytical skills; ability to independently research, document, and present solutions
- Strong documentation and organizational skills
- Strong interpersonal, communication, and facilitation skills
- Ability to multi-task and manage concurrent projects
- Knowledge of Microsoft Excel and Microsoft Word
- Ability to develop, execute, and complete test plans and perform claims testing
What We Do
At Blue Cross & Blue Shield of Mississippi, we work daily to help Mississippians find their personal answers to this question through health and wellness partnerships with quality healthcare providers, employer groups and community leaders across the state. Our goal is to help each person along their journey to a healthier life… their Blue Wellness Journey. Our health and wellness benefits are designed to support our members in understanding their health and in receiving the care they need at the right time and place, beginning with establishing a healthy relationship with a Primary Care Network Provider through an annual wellness visit at no out-of-pocket cost. We partner with our Network Providers to ensure the highest quality, evidence-based care is provided in each care setting from primary care to specialty care through our Primary Care Home, Blue Distinction+ Centers of Excellence and Maternity Care Quality initiatives. We partner with employer groups to make every workplace a healthy workplace by providing tools and information to help employees take ownership of their health and understand and make the most of their benefits, all while working to manage health and healthcare costs. We partner with community leaders and organizations to make healthy living resources available to all Mississippians through the work of the Blue Cross & Blue Shield of Mississippi Foundation, our support of the arts and culture and our Team Blue volunteers. These partnerships and our dedicated team of employees are making a difference every day, in our communities and in the lives of each person we reach. So, what does it mean to be healthy? The answer is about you, your health, your life… and all its possibilities. Live healthy. Live Blue.
