Healthcare Audit Analytics Lead

Blue Cross Blue Shield; Chicago (IL); On-site; USD 98,000 - 142,000; Full time

Job summary

Blue Cross and Blue Shield Association seeks a seasoned analytics professional to lead audits of incentive programs, develop business solutions, and analyze financial, medical and enrollment data to improve the efficiency of the Audit Program.

Responsibilities include managing audit activities, implementing prepayment controls in the Claims System, providing technical support across audits, and collaborating with BCBS plans to translate requirements into system enhancements.

Qualifications

• Bachelor's degree in business administration with MIS or health care, or equivalent work experience.
• 5+ years specific formal software/system testing experience in a business environment; within a managed care or health services delivery setting.
• Strong SQL, VBA, Excel, and data analysis skills required.

Responsibilities

• Lead audits of the BCBS incentive program and develop automation for payments.
• Implement prepayment controls in the BCBS Claims System to ensure accurate claims adjudication.
• Provide ongoing technical support to Audit teams and affiliated plans throughout the life-cycle of audits.
• Collaborate on initiatives involving healthcare data and information solutions and ensure requirements translate into system enhancements.

Skills

SQL

Excel

Visual Basic

Tableau

Predictive modeling

Risk stratification

Data analysis

Data modeling

Communication

Auditing knowledge

Education

Bachelor's Degree in Business Administration (MIS/health care)

Master's Degree

Tools

Microsoft Access

VBA

SQL

Job description

Blue Cross and Blue Shield Association seeks a seasoned analytics professional to lead audits of incentive programs, develop business solutions, and analyze financial, medical and enrollment data to improve the efficiency of the Audit Program.

Responsibilities include managing audit activities, implementing prepayment controls in the Claims System, providing technical support across audits, and collaborating with BCBS plans to translate requirements into system enhancements.