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IDR Reimbursement Analyst

Blue Cross Blue Shield of Kansas

Topeka, Kansas

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JOB DETAILS
SKILLS
Accounting, Analysis Skills, Automation, Benchmarking, Content Management Systems (CMS), Continuous Improvement, Cross-Functional, Data Quality, Dental Insurance, Documentation, Finance, Financial Analysis, Financial Trend Analysis, Fitness, Healthcare, Healthcare Reimbursement, Incentive Programs, Leadership, Legal, Mathematics, Negotiation Skills, Pricing, Process Improvement, Provider Relations, Regulations, Regulatory Compliance, Reimbursement, Requirements Management, Statistics, Strategic Analysis, System Test, Team Player, Technical Analysis, Training Program, Training/Teaching, Vision Plan
LOCATION
Topeka, Kansas
POSTED
14 days ago
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.
  • FamilyComes 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, Ris

About the Company

B

Blue Cross Blue Shield of Kansas

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