Reference Based Pricing Analyst


Atlanta, GA, US / Bedminster, NJ, US
  • Job Type: Full-Time
  • Function: Data Science
  • Post Date: 04/28/2021
  • Website:
  • Company Address: 2 Crossroads Drive, Bedminster, NJ, 07921

About Zelis

Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims.

Job Description

Description & Requirements

Position Overview:


The RBP Analytics role will serve as a subject matter expert on reference-based pricing (RBP) methodologies and fee schedules that support Claims Cost Solutions (CCS).  The position will be responsible for analysis related to RBP to determine effectiveness of results, identification of gaps, and overall performance.


Key responsibilities:


  • Performs modeling, impact analysis and audits on variations in reimbursements
  • Serve as subject matter expert in all areas of fee schedules, rate reimbursement, and payment methodologies
  • Effectively operates with high volumes of claims and provider data
  • Provides insights on RBP benchmark data and communicates areas of opportunity
  • Responsible for the identification, correction, and root cause analysis of RBP fee schedule load and reimbursement problems
  • Partners with solution owners to integrate RBP knowledge into business with emphasis in provider contracting and negotiations
  • Works with RBP solution owner to define ongoing pricing strategies and revenue optimization





Technical Skills / Knowledge:

  • Strong analytical mindset and ability to use technical toolsets
  • Advanced excel user and supporting Microsoft Office
  • Data mining experience and reporting required
  • Use of business intelligence solutions to support key responsibilities and strategies


Independence/ Accountability:

  • Ability to work in a high change environment


Problem Solving:

  • Makes logical suggestions as to likely causes of problems and independently recommends solutions
  • Excellent organizational skills are required to prioritize responsibilities
  • Outstanding ability to multiplex tasks as required
  • Excellent project management skills
  • Attention to detail and concern for impact is essential


Leadership Activities:

  • Must be proactive to business needs and understand implications to revenue
  • Must maintain a professional demeanor in sensitive situations
  • Must be able to translate complex data results into appropriate, actionable insights


Communication Skills:

  • Must have excellent communication skills
  • Must work well with others
  • Effectively communicate with others by giving and receiving feedback
  • Communicates ideas and information clearly
  • Must have excellent communication and presentation skills to effectively interface with internal and external audiences


Business-related Travel:

  • Limited



professional experience:


·         3-5 Years previous experience in Healthcare data analysis and insights

·         Direct prior exposure to reimbursement analysis, fee schedules, and claims benchmarking

·         Full SME oriented knowledge of CMS Medicare reimbursement methods and processes

·         Service oriented experience with proven customer satisfaction (internal or external) preferred

Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims. Zelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers' compensation markets nationwide. Zelis is backed by Parthenon Capital Partners and Bain Capital.
“We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.”

Related Jobs

Director of Quality Assurance

Zelis - New Jersey, USAtlanta, GA, US

Client Data Administrator

Zelis - Atlanta, GA, USBedminster, NJ, US

Customer Care Specialist

Zelis - Bedminster, NJ, US

Customer Care Specialist

Zelis - Atlanta, GA, US

Supervisor, Customer Care

Zelis - Bedminster, NJ, US
Disclaimer: Local Candidates Only
This company does NOT accept candidates from outside recruiting firms. Agency contacts are not welcome.