Network Reimbursement Analyst

				Overview:

St. Luke's Health Partners is a clinically integrated network with about 300,000 attributed members across Idaho. We are committed to advancing value-based care by improving outcomes, enhancing patient experience, and reducing costs through data-driven insights and actionable analytics.

The Network Reimbursement Analyst is responsible for developing, maintaining, and updating SLHP's fee schedule, pricing updates, and reimbursement policy execution. The role evaluates Medicare and industry changes, translates coding and regulatory updates into pricing recommendations, and models the financial impact of reimbursement decisions on provider performance and network affordability.

**Full-time or part-time option**

What You Can Expect:

* Support the development, updates, and maintenance of SLHP professional and facility fee schedules by applying established pricing methodologies (percent-of-Medicare, custom rates, case rates, blended models) and ensuring accuracy across annual update cycles.
* Monitor and interpret Medicare updates, CPT/HCPCS changes, RVU shifts, APC/DRG refinements, modifier rules, NCCI edits, and payer policy changes; prepare analytical summaries and recommended pricing adjustments.
* Build and maintain models using claims, clinical, and operational data to evaluate the financial and operational impact of reimbursement changes on provider revenue, medical spend (PMPM), site-of-service patterns, and value-based care programs.
* Prepare scenario models, forecasts, dashboards, and ad-hoc analyses to support payer contracting, strategy development, and network performance monitoring.
* Perform post-claims audits, confirm alignment with fee schedules and reimbursement policies, and collaborate with Data & Analytics teams to validate datasets and ensure analytical reliability.
* Collaborate with contracting, provider relations, finance, and analytics partners to provide reimbursement insights and communicate findings clearly to a variety of stakeholders.
* Document pricing logic, analytic assumptions, data sources, and methodologies; contribute to analytical best practices and team knowledge-sharing.

Qualifications:

* Bachelor's degree or experience in lieu of degree
* 4 years' relevant experience

*Remote work supported from the Idaho, Oregon, Utah, and Arizona ONLY*

Responsibilities:

Under limited supervision, the Network Reimbursement Analyst is responsible for performing provider reimbursement analysis,
projections, and modeling to support payer and provider contracting decisions. This position provides a wide range of support to
the Network related to payment policies, contract settlement, and fee schedule updates.
Responsibilities

- Performs complex analysis utilizing claims data and industry standard payment methodologies to model financial impacts of
network reimbursement changes. Analyzes and interprets financial data, discerns important trends that can be used by
management for decision making.

- Develops, coordinates, and manages analysis accompanying existing and new reimbursement models. Provides analysis in the
development and support of VBR (value-based reimbursement) projects and information required to make effective business
decisions. Recommends innovative approaches to VBR models and programming.

- Creates a comprehensive suite of reimbursement models that align with enterprise goals and strategic objectives across the enterprise.

- Leads the maintenance/maturation of in-market VBR models and the development of new VBR models, partnering with internal
stakeholders and aligning to broader organizational strategies and goals.

- Provides reporting of reimbursement impacts to be utilized in value-based arrangement contracting decisions and financial forecasting.

- Analyzes reimbursement practices, policies, and procedures to optimize reimbursement activities. Tracks and communicates
industry updates that impact reimbursements. Recommends courses of action to management as it relates to fair, equitable, and
market competitive reimbursements designed to achieve value for the Health Plan, provider partners, and members.

- Collaborates on the development and implementation of improved infrastructure and processes to provide the Network with
regular performance scorecards highlighting initiative implementation successes, accountability, and "capture" of initiative
benefits, activity, progress, and identification of barriers.

- Conducts post-claims audits for accuracy and compliance with the Network fee schedules and policies. Monitors contracts that include charge description master increase protection.

- Assist with reconciliation and administration of payment processes for payors and providers in coordination with finance.

- Works collaboratively with interdisciplinary team to ensure understanding and adherence to standards of practice and relevant
policies and procedures for areas of oversight. Serves as a liaison among numerous internal and external customers, including but
not limited to VBR team members, operations, actuary, provider relations, strategic integration and advanced analytics and
reporting.

- Performs other duties and responsibilities as assigned.

Qualifications:

* Education: Bachelor's Degree or additional experience in lieu of
* Experience: 4 years' relevant experience
			

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