Pricing Reimbursement Analyst I/II

Cambia Health Solutions

. Analyze, develop, and maintain contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers .

Posted 11/3/2026full-timeUnited StatesJuniorMid-Level💰 $49,000 - $108,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in analyzing and developing healthcare provider contract payment terms and reimbursement methodologies, with a strong focus on accuracy and compliance. Proficient in claims processing, data analysis, and effective communication to support corporate projects and provider relations.

Highest-signal resume keywords

Claims Processing ExperienceReimbursement Methodologies KnowledgeSQL Query Development ProficiencyMicrosoft Office Suite ProficiencyLeadership in Corporate Projects

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Contract Payment AnalysisReimbursement Strategy DevelopmentData AnalysisCPT CodingICD-9 CodingDRG CodingAP-DRG CodingHCPCS CodingProblem Identification and Solution ImplementationDocumentation Authoring

Soft Skills

Attention to DetailStrong Verbal CommunicationStrong Written CommunicationIndependent Work AbilityAnalytical Ability

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft AccessRegence Plan Systems

Industry Keywords

Healthcare Industry ExperienceProvider ContractsBilling PracticesPricing LogicCorporate Projects

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Analyze, develop, and maintain contract payment terms and reimbursement rates for institutional, facility, and professional healthcare providers
Implement and sustain accurate contract payments negotiated by Regence
Collaborate with Provider Services, Network Management, corporate business support, operations staff, and other teams
Load and maintain rates in system files to price professional and facility claims accurately
Research, analyze, and implement provider reimbursement methodologies
Support development of new reimbursement strategies
Create payment exhibits attached to provider contracts
Maintain updates to CPT, DRG, AP-DRG, HCPCS, per diem, ICD-9, and HCPCS coding changes
Research contract and pricing issues that may cause overpayments or underpayments
Recommend corrective actions and coordinate solution implementation
Liaise with internal departments regarding provider, hospital, and contracted-facility contract and billing issues
Maintain computer hardware and software
Recommend equipment or software purchases supporting pricing schedules and methodologies
Provide documentation for end-user processing guidelines
Participate in the local Regence Reimbursement Subcommittee
Represent the Regence plan at state or regional meetings and committees

Requirements

What you’ll need

Bachelor’s degree in business or related field and at least two years of health care industry experience, with one year of project-related experience, or equivalent combination of education and work experience
Minimum of three years claims processing experience
Knowledge of various reimbursement methods
Pricing and Reimbursement Analyst II requires at least two years of direct Pricing & Reimbursement Analyst experience
Pricing and Reimbursement Analyst II requires demonstrated leadership in corporate projects, significant decision-making, and active participation while a Pricing and Reimbursement Analyst Level I
Ability to read, interpret, and apply provider contracts, medical/hospital pricing methodologies, and billing practices
Strong attention to detail and accuracy
Understanding of Regence plan systems and pricing logic
Analytical ability to identify problems, develop solutions, and implement effective actions
Ability to work independently with minimal supervision
Strong verbal and written communication skills
Ability to contribute to and lead corporate projects
Proficiency in Microsoft Office Suite, including Excel, Word, and Access
SQL query development proficiency
Ability to analyze data, identify discrepancies, and validate updates
Ability to review and audit peers’ work
Ability to author and enhance team documentation
Background check required
For remote work, wired internet connection required; minimum 5Mb upload and 10Mb download speeds; satellite or cellular internet not accepted
Personal mobile device required for MFA setup

Benefits

Comp & perks

Competitive base pay
Bonus opportunities; 6% bonus target
Medical, dental and vision coverage for employees and eligible family members, including mental health benefits
Annual employer contribution to a health savings account
Generous paid time off
10 company-paid holidays
401(k) retirement plan with significant company match
Potential discretionary retirement contribution based on company performance, with no vesting period
Up to 12 weeks of paid parental time off after 12 months of continuous service
Award-winning wellness programs that reward participation
Employee Assistance Fund
Commute and parking benefits
Work-from-home options for most roles
Employee resource groups
Cambia-supported community outreach programs
Wired internet and personal mobile device support/requirements for remote work and MFA access