Job Description
Note: The job is a remote job and is open to candidates in USA. St. Luke's Health System is a clinically integrated network committed to advancing value-based care through data-driven insights. The Network Reimbursement Analyst will develop and maintain fee schedules, evaluate Medicare changes, and model the financial impact of reimbursement decisions. Responsibilities • 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. Skills • Bachelor's degree or experience in lieu of degree • 4 years' relevant experience Benefits • On-site massages • On-site counseling via our Employee Assistance Program • Access to the Personify Health Wellness tool • Other formal training and career development offerings Company Overview • St. Luke's Health System is a healthcare facility offering internal medicine and urgent care services. It was founded in 1902, and is headquartered in Boise, Idaho, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship • St. Luke's Health System has a track record of offering H1B sponsorships, with 2 in 2025, 9 in 2024, 7 in 2023, 1 in 2022, 7 in 2021, 3 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job