Healthcare Price & Transparency Analyst

Blue Cross and Blue Shield of Louisiana Inc.; Baton Rouge (LA); On-site; USD 70,000 - 110,000; Full time

Job summary

Blue Cross and Blue Shield of Louisiana is seeking an experienced pricing and transparency analyst to ensure cost visibility for members and to support reimbursement operations. The role collaborates with IT, vendors and cross-divisional teams to enhance data infrastructure and compliant reporting.

The ideal candidate will have a strong foundation in healthcare analytics, proficiency in SQL, and experience with tools like Tableau or Power BI, plus a background in provider payment methods.

Qualifications

• Bachelor’s degree required.
• Master’s degree preferred.
• Four years of related experience can be used in lieu of a Bachelor’s degree.
• 2 years of analytical experience in healthcare, IT, finance and/or related industries required.
• Basic understanding of provider payment methodologies, complex provider contracts, medical coding, analytic pricing transparency initiatives preferred.
• Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. preferred.

Responsibilities

• Refine, implement, automate, and manage the reimbursement operations strategy using existing software and applications.
• Collaborate with vendors, IT and cross-divisional teams to improve reimbursement operations and data infrastructure.
• Support design, configuration, implementation, maintenance and documentation of transparency cost algorithms for internal and external initiatives (Axis, AIM Smart Shopper, Sapphire Digital).
• Assess reimbursement area operations, determine requirements, identify opportunities for improvement, and design business/tech solutions with testing and controls.
• Perform data transformation, validation, reporting, and analytics to ensure compliance with Blue Cross Association and federal mandates.

Skills

SQL

Analytical thinking

Excel

Power BI

Tableau

Communication skills

Education

Bachelor's degree

Master's degree

Tools

Azure Databricks

Snowflake

Microsoft SQL Server

Job description

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 us. 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.

Reports to: Manager, Healthcare Price and Transparency.

Necessary Contacts

• Network Administration Management
• IT Management
• Benefits Administration Management
• Medical Management
• Medical Coding
• Payment Integrity
• Business Engineering Team
• Project Management Office
• Blue Cross Association
• other health plans and software vendors

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.
• 2 years of analytical experience in healthcare, IT, finance and/or other related industries required.
• Basic understanding of provider payment methodologies, complex provider contracts, medical coding, clinical editing, analytic driven healthcare pricing transparency initiatives or equivalent experience is preferred.
• Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. is preferred.

Skills and Abilities

• 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.
• Experience with analytic/visualization tools such as Tableau, Power BI, etc. is required.
• Strong analytical and critical thinking skills 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 is 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.

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Works closely with senior team members and 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).
• Assists in assessing 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.

An Equal Opportunity Employer

An Equal Opportunity Employer

Additional Information

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact [e-mail] for assistance.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors.

We want to ensure that our employees have a work environment that will optimize personal health and well-being.

Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions.

As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus.

Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, we are a Drug Free Workplace.

A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

Company Mission

To improve the health and lives of Louisianians.

Company Vision

A better state of health through preventative, easier and more affordable healthcare.

Company Description

Blue Cross and Blue Shield of Louisiana (Louisiana Blue) is incorporated as Louisiana Health Service & Indemnity company and is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross and Blue Shield of Louisiana is licensed to sell products only in the state of Louisiana.