Healthcare Price & Transparency Analyst

Blue Cross and Blue Shield of Louisiana; Baton Rouge (LA); On-site; USD 70,000 - 100,000; Full time

Job summary

Blue Cross and Blue Shield of Louisiana seeks a pricing and transparency analyst to support reimbursement operations and build compliant, scalable reporting infrastructure.

You will leverage SQL and BI tools to transform data, design cost algorithms, and present complex financial analyses to internal teams and external vendors. Louisiana residency preferred, with Health care pricing focus and strong communication skills.

Qualifications

• Bachelor's degree in a related field is required.
• Master’s degree (MBA/MPH/MS/MA) preferred.
• Four years of related experience can substitute for a degree.
• 2 years of analytical healthcare/IT/finance experience required.
• Understanding of provider payment methodologies and pricing transparency preferred.
• Knowledge of APC, DRG, MPFS, CCI and related healthcare payment concepts.

Responsibilities

• Refine and manage reimbursement operations strategy with senior team input.
• Collaborate with vendors and IT to implement transparency cost algorithms.
• Design/configure tests, controls and protocols for data quality and reporting.
• Perform data transformation, validation, reporting and analytics to ensure compliance.

Skills

SQL

Tableau

Power BI

Analytical

Communication

Excel Pivot Tables

MS Office

Fast-paced

Education

Bachelor’s degree in related field

Master’s degree preferred

Four years of related experience can substitute a Bachelor’s degree

Tools

SQL Server

Azure Databricks

Snowflake

Tableau

Power BI

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
• This role reports to this job: Manager, Healthcare Price and Transparency
• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:
  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 in order to successfully configure and implement new and innovative payment programs that support Healthcare Reform.

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

• 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

All internal employees please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the “My Applications” section in the Candidate Home section of your Workday account.

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.