IDR Reimbursement Analyst

Blue Cross Blue Shield of Kansas • Topeka, KS • 11h ago

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13559744 **Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

You Belong At Blue

Why Join Us?**

Make a Positive Impact: Your work will directly contribute to

the health and well-being of Kansans.

Family Comes First: Total rewards package that promotes the

idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire

Professional Growth Opportunities: Advance your career with

ongoing training and development programs.

Dynamic Work Environment: Collaborate with a team of passionate

and driven individuals in a work environment that promotes flexibility.

Trust and Stability: Work for one of the most trusted companies

in Kansas with over 80 years of commitment, compassion and community.

Inclusive Work Environment: We pride ourselves on fostering a

workplace where everyone is valued and respected.

Benefits & Perks

Base compensation is only one component of your competitive Total

Rewards package

Incentive pay program (EPIP)

Health/Vision/Dental insurance

6 weeks paid parental leave for new mothers and fathers

Fertility/Adoption assistance

2 weeks paid caregiver leave

401(k) plan matching up to 5%

Tuition reimbursement

Health & fitness benefits, discounts and resources

Job Summary

The IDR Reimbursement Analyst is responsible for overseeing the development, implementation, and continuous improvement of reimbursement strategies specifically supporting Independent Dispute Resolution (IDR) and the development of Open Negotiation amounts under the No Surprises Act. This role ensures that IDR reimbursement analyses and negotiation support align with contractual agreements and healthcare regulations, while leading advanced financial and technical analyses and providing strategic recommendations to support accurate, defensible provider payment outcomes. The Analyst collaborates with cross-functional teams and drives process improvement, automation, and documentation across IDR reimbursement workflows. The Analyst will also be responsible for the creation of complex reimbursement and negotiation models.

\"This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.\"

What you\'ll do

Lead the analysis, development, and maintenance of reimbursement

methodologies supporting Open Negotiation and IDR, ensuring alignment with contractual agreements and compliance with regulatory standards.

Develop and maintain Open Negotiation amounts using claims

experience, contractual terms, QPA-related inputs, external benchmarks, and internal pricing methodologies; ensure outputs are defensible and consistently documented.

Provide in-depth financial analyses on reimbursement rates, provider

payment structures, claim trends, and dispute outcomes, offering insights for strategy and process improvement.

Collaborate with internal departments (Provider Relations, Claims,

IT, Compliance, and Legal) and external stakeholders to support IDR case workflows, implement reimbursement models, and ensure consistent operational execution.

Lead initiatives to optimize IDR reimbursement processes,

identifying opportunities to improve efficiency, reduce manual effort, strengthen auditability, and enhance internal stakeholder experience.

Act as a subject matter expert on provider reimbursement

methodologies, including fee-for-service, CMS IPPS, and CMS OPPS, and how these relate to dispute resolution and negotiation support.

Oversee and conduct system testing and validation to ensure data

integrity in payment/analytics systems and the accuracy of reimbursement and IDR-related outputs.

Develop, maintain, and automate reporting for IDR volume, cycle

times, outcomes, financial impacts, and drivers; ensure reporting is consistent, reliable, and leadership-ready.

Lead project workstreams related to IDR and reimbursement analytics

(requirements, timelines, deliverables, risks/issues, stakeholder updates).

Prepare and present comprehensive reports to senior leadership

summarizing IDR trends, financial performance, negotiation drivers, and recommendations for process or policy enhancements.

What you need

Education and Experience:

High school diploma or equivalent required. Bachelor\'s degree in Finance, Accounting, Mathematics, Statistics, Risk Management, Economics, Health Care or related degree, preferred. In lieu of degree, 5 years managed care billing or pricing / financial analysis experience is required.

A minimum of five years\' experience with technology administration, health care reimbursemen

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