Blue Cross and Blue Shield of Louisiana Jobs
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. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSE
Performs pricing and transparency reporting functions to ensure adherence to Blue Cross Association and federal mandates to provide members with the cost of common medical procedures, surgeries, treatments, etc. as well as quality of care information. Supports facility and professional reimbursement areas through implementation of new processes, procedures, reports, software and the refinement of existing operations. Collaborates with multiple cross-divisional business areas and vendors to improve reimbursement operations, solve organizational information challenges and build an efficient, effective and compliant technical analytical reporting infrastructure.
NATURE AND SCOPE
This role does not manage people.
This role reports to: Manager, Healthcare Price & Transparency.
QUALIFICATIONS
Education
Bachelor's degree in a related field, preferably in health care administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or related quantitative or health care field is required.
Master's degree such as MBA, MPH, MS or MA preferred.
Four years of related experience can be used in lieu of a Bachelor’s degree.
Work Experience
4 years of experience in healthcare, analytics, IT and/or in the finance industry to include provider payment methodologies, complex provider contracts, medical coding, clinical editing, analytic driven healthcare pricing transparency initiatives or equivalent experience required.
2 years of experience leading analytics projects involving cross-functional teams including business operations and IT required.
Skills and Abilities
Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. required.
Must have extensive knowledge of SQL including writing queries, importing data, and creating tables and views. This includes environments such as Microsoft SQL Server, Azure Databricks and/or Snowflake.
Strong experience with analytic/visualization tools such as Tableau, Power BI, etc. is required.
Strong analytical skills, critical thinking skills and a comprehensive understanding of all aspects of healthcare financing and provider reimbursement, including industry-wide (private and governmental) payment methodologies are required.
Requires excellent oral and written communication skills including the demonstrated ability to present complex financial analysis and technical topics to all levels of internal staff and external vendors in a clear and understandable manner.
Extensive knowledge of Microsoft Office products including Excel (including Pivot Tables) and Power Point required.
Requires the ability to work proficiently in a fast-paced, demanding environment.
Licenses and Certifications
- Medical coding designation such as CPC or CPHC is preferred upon hire; but must be attained within 24 months.
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Works closely with the Manager, Healthcare Price and Transparency to continually refine, implement, automate, and manage the reimbursement operations strategy, focusing on the efficient, compliant and cost-effective use of existing software and applications.
Collaborates with vendors, IT and multiple cross-divisional business areas to improve reimbursement operations, solve organizational information challenges and build an efficient, effective and compliant technical analytic reporting infrastructure.
Supports the design, configuration, implementation, maintenance and documentation of transparency cost algorithms for internal and external transparency initiatives (e.g. Blue Cross Blue Shield Association's Axis system, AIM Smart Shopper, and Sapphire Digital).
Assesses reimbursement area operations, determines business requirements, identifies opportunities for improvement and assists with designing business and technology systems, recommending business process improvements, system testing, controls and protocols.
Performs other pricing and transparency related functions including, but not limited to, data transformation, data validation, reporting, and analytics to ensure compliance with Blue Cross Association and federal mandates along with meeting organizational goals.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
JOB CATEGORY: Data Analytics/Warehousing, & Business Intelligence
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