Pricing Reimbursement Analyst I or II

Pricing and Reimbursement Analyst I or II, DOE

Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston, Little Rock, and Springdale offices.

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo, Lewiston, Little Rock, and Springdale offices, or who are willing to relocate.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

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

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

Oregon, Utah, and Idaho: The expected hiring range for the Pricing and Reimbursement Analyst I is $58,700 - $79,400, the full range is $55,000 - $90,000 and the bonus target for this role is 6%. The expected hiring range for the Pricing and Reimbursement Analyst II is $70,600 - $95,500 and the full range is $66,000 - $108,000. The bonus target for this role is 6%.

North Dakota: The expected hiring range for the Pricing and Reimbursement Analyst I is $52,800 - $71,400 the full salary range is $49,000 - $81,000. The bonus target for this role is 6%. The expected hiring range for the Pricing and Reimbursement Analyst II is $63,500 - $85,900 and the full range is $59,000 - $98,000. The bonus target for this role is 6%.

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.