Payment Integrity Financial Specialist

bcbsla; Baton Rouge (LA); On-site; USD 65,000 - 95,000; Full time

Job summary

bcbsla in Louisiana seeks an experienced Payment Integrity Analyst to provide advanced financial analysis, reconciliation, and monitoring of payments, invoices, and vendor activity. The role focuses on accuracy, regulatory compliance, and delivering insights to improve efficiency and cost containment.

Responsibilities include validating invoices, performing variance analysis, and developing data-driven reports for leadership.

Qualifications

• Bachelor's degree required; 4 years of related experience may substitute for degree.
• 2 years of healthcare industry experience in financial analysis, payment integrity, provider contract analysis, internal audit, or value-based care.
• 1 year of experience solving complex business, financial, or clinical problems through data analysis.
• Experience with payments, invoices, billing activity, and GL transactions.
• Strong analytical, mathematical, and problem-solving skills with attention to detail.
• Excellent written and verbal communication, ability to present findings to leadership.
• Advanced proficiency with Microsoft Excel and Office applications.
• Ability to analyze large financial/operational data and work independently in a fast-paced environment.

Responsibilities

• Analyze and reconcile Payment Integrity program payments, billings, invoices, and related financial transactions for accuracy and compliance.
• Validate vendor invoices and payments against contracts, expected savings, and performance metrics.
• Perform financial analysis, variance reporting, cost savings validation, and performance monitoring.
• Identify discrepancies, conduct root cause analyses, and collaborate with stakeholders to resolve issues.
• Develop reports and data-driven recommendations to improve efficiency and financial stewardship.
• Serve as SME for payment integrity data supporting audits, compliance, and cross-functional initiatives.

Skills

Financial analysis

Data analysis

Excel

Communication

Problem-solving

Attention to detail

Education

Bachelor's degree in Healthcare, Finance, Accounting, Business Administration, or related field

Tools

SQL

Excel

BI tools

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.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

Provides advanced technical, analytical, and financial support for Payment Integrity programs through the analysis, reconciliation, monitoring, and validation of financial and operational data. This role ensures the accuracy of program payments, billings, vendor financial activity, and cost containment initiatives while delivering actionable insights that improve operational performance, financial outcomes, and regulatory compliance.

How You Contribute to the Company's Mission In This Role

• Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance.
• Validate vendor invoices and payments against contractual terms, expected savings, and program performance metrics.
• Perform financial analysis, variance reporting, cost savings validation, and performance monitoring for Payment Integrity initiatives.
• Identify discrepancies, conduct root cause analyses, and partner with internal and external stakeholders to resolve issues and improve processes.
• Develop methodologies, reports, and data-driven recommendations that support operational efficiency, financial stewardship, and strategic decision-making.
• Serve as a subject matter expert for Payment Integrity financial and operational data while supporting audit, compliance, and cross-functional initiatives.

Required Qualifications

• Bachelor's degree in Healthcare, Finance, Accounting, Business Administration, or a related field; 4 years of related experience may be substituted in lieu of a degree.
• 2 years of healthcare industry experience in one or more of the following areas: Financial analysis, Payment integrity or reimbursement analysis, Provider contract analysis, Internal audit, and/or Value-based care programs
• 1 year of experience solving complex business, financial, or clinical problems through data analysis.
• Experience performing financial reconciliations involving payments, invoices, billing activity, and General Ledger transactions.
• Strong analytical, mathematical, and problem-solving skills with demonstrated attention to detail and accuracy.
• Excellent written and verbal communication skills, including the ability to present findings and recommendations to leadership.
• Advanced proficiency with Microsoft Excel and Microsoft Office applications.
• Ability to analyze, interpret, reconcile, and summarize large volumes of financial and operational data.
• Ability to work independently in a fast-paced, deadline-driven environment.

Preferred Qualifications

• Certified Professional Coder (CPC) certification upon hire; required within two years of placement in the role.
• Experience reviewing and validating vendor invoices, payment calculations, and financial performance guarantees.
• Knowledge of healthcare claims processing systems, reimbursement methodologies, and health plan operations.
• Experience with provider reimbursement reviews, including compounded drug claim reimbursement calculations.
• Experience supporting Accounts Payable, Accounts Receivable, or similar financial operations.
• Knowledge of internal controls, audit practices, regulatory compliance, and financial governance requirements.
• Experience with relational databases, SQL, data reporting, and business intelligence tools.
• Understanding of Inter-Plan Payment Integrity activities and related reporting requirements.
• Proven ability to identify opportunities for process improvement, operational efficiency, and cost containment.

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.

An Equal Opportunity Employer