[Hiring] Senior Healthcare Data Analyst @Blue Cross and Blue Shield of Louisiana

Role Description

Independently researches, analyzes, develops and maintains new and existing, complex reimbursement programs. Designs system specifications that support claims payment and criteria for databases that support analysis as well as training documentation describing programming, billing and payment guidelines for internal and external use. Designated staff may focus primarily on supporting the Medicare Advantage line of business.

This role does not manage people and reports to the MANAGER, PROVIDER REIMBURSEMENT.

Necessary Contacts:

• All levels of internal personnel, primarily in Network Administration, IT, Medical Management, Benefits Administration, Actuarial, Legal, Executive, Marketing, and Underwriting.
• Providers, provider representatives, consultants, provider specialty organizations, AMA, vendor reps, and hospital administrators to exchange or review program information.
• Other data sources include market research consultants, AMA, St. Anthony, Relative Value Studies for Dentists, Dun and Bradstreet, HIAA, CMS, Blue Cross and Blue Shield Association, Blue Cross and Blue Shield Plans, CMS, DHS, sales and marketing regional offices.

Qualifications

• Bachelor's degree in statistics, accounting, finance, math or related field is required.
• Prefer a Master's Degree or pursuit of a Master's degree in Business, Information System and Decision Sciences, Healthcare Administration or Public Health.
• Four years of related experience can be used in lieu of a Bachelor’s degree.
• 4 years of experience in the health industry accounting functions including billing, coding, Medicare or statistical analysis of financial information is required.
• Provider contract analysis and/or reimbursement program implementation experience is strongly preferred.
• Excellent analytical, oral and written communication, and report preparation skills with the highest degree of accuracy are required.
• Requires strong math/analytical skills including variance analysis, statistical formulas, algebraic formulas, percentages, multiplication and division, fractions and reasonableness tests.
• Excellent attention to detail, research, and documentation skills are required.
• Proficiency with commonly used database, spreadsheet and word processing software is required.
• Familiarity with relational database software, mainframe capabilities, FOCUS and SQL programming is helpful and preferred.
• A strong understanding of physician charge practices and billing methodologies is helpful.
• Minimal travel is required, which may involve going to regional offices and/or conferences and exhibits.
• Staff dedicated to supporting Medicare Advantage must have working knowledge of Medicare enrollment guidelines and reimbursement.
• Pursuit of coding (CPC or CPHC) designation is preferred.

Requirements

• Serves as provider reimbursement technical advisor and/or committee participant to Information Technology staff, Benefits Administration staff, Provider Audit, Network Administration and/or Medicare Advantage staff, and entry level Reimbursement Analyst.
• Identifies claims and provider reimbursement related system problems, including claims coding and processing issues.
• Researches, designs, implements, and maintains complex hospital or professional provider reimbursement programs for traditional and managed care programs and Medicare Advantage.
• Leads in the development of complex financial pricing models and financial data analysis to support modifications to reimbursement programs.
• Provides statistical reports to Network Administration, Medical Management, Marketing and Medicare Advantage to support internal strategies and external customer needs.
• Complies with Corporate Objectives on project implementation and schedule deadlines.
• Accountable for complying with all laws and regulations associated with duties and responsibilities.

Benefits

• We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities.
• Residency in or relocation to Louisiana is preferred for all positions.