Senior Healthcare Data Analyst (Reimbursement)

Blue Cross and Blue Shield of Louisiana; Baton Rouge (LA); On-site; USD 65,000 - 90,000; Full time

Job summary

Blue Cross and Blue Shield of Louisiana is seeking a provider reimbursement analyst to independently research, analyze, design and maintain reimbursement programs. The role emphasizes billing guidelines, data analysis and system requirements across multiple departments.

The position requires strong analytical, communication and documentation skills, with knowledge of Medicare enrollment guidelines and reimbursement practices. Louisiana residency or relocation is preferred.

Qualifications

• Bachelor’s degree in statistics, accounting, finance, math or related field is required.
• Master’s degree preferred in relevant fields.
• Four years of related experience can be used in lieu of a Bachelor’s degree.

Responsibilities

• Serves as provider reimbursement technical advisor and/or committee participant to IT staff, Benefits Administration staff, Provider Audit, Network Administration and/or Medicare Advantage staff.
• Develops and implements project/program narratives and responds to concerns on new and existing reimbursement programs, billing guidelines, and system requirements to ensure accurate implementation and maintenance.
• Identifies claim issues and collaborates with internal teams to resolve them.

Education

Bachelor's degree in statistics, accounting, finance, math or related field

Master's degree preferred (Business, Information System and Decision Sciences, Healthcare Administration or Public Health)

Four years of related experience can be used in lieu of a Bachelor’s degree

Tools

SQL

FOCUS

Relational databases

Mainframe capabilities

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

Independently researches, analyzes, develops and maintains new and existing, complex reimbursement programs. Designs system specifications that support claims payment and criteria for data bases that support analysis as well as training documentation describing programming, billing and payment guidelines for internal and external use. Designated staff may focus primarily on supporting the Medicare Advantage line of business.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: MANAGER, PROVIDER REIMBURSEMENT
• Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with: All levels of internal personnel, with primary contacts in Network Administration, IT, Medical Management, Benefits Administration, Actuarial, Legal, Executive, Marketing, and Underwriting. Providers, provider representatives, consultants, provider specialty organizations, AMA, vendor reps, and hospital administrators to exchange or review program information. Other data sources are market research consultants, AMA, St. Anthony, Relative Value Studies for Dentists, Dun and Bradstreet and HIAA, CMS, Blue Cross and Blue Shield Association, Blue Cross and Blue Shield Plans, CMS, DHS, sales and marketing regional offices.

QUALIFICATIONS

Education

• Bachelor's degree in statistics, accounting, finance, math or related field is required
• Prefer a Master's Degree or pursuit of a Master's degree in Business, Information System and Decision Sciences, Healthcare Administration or Public Health.
• Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

• 4 years of experience in the health industry accounting functions including billing, coding, Medicare or statistical analysis of financial information is required
• Provider contract analysis and/or reimbursement program implementation experience is strongly is preferred

Skills and Abilities

• Must have acquired sufficient knowledge to function autonomously and to know the appropriate contacts within departments to resolve specific issues for all lines of business.
• Excellent analytical, oral and written communication, and report preparation skills with highest degree of accuracy are required. Must have the ability to effectively present information to Executive Management and all levels of employees.
• Requires strong math/analytical skills including variance analysis, statistical formulas, algebraic formulas, percentages, multiplication and division, fractions and reasonableness tests.
• Excellent attention to detail, research, and documentation skills are required.
• Proficiency with commonly used database, spreadsheet and word processing software is required. Must have extensive knowledge to select the appropriate database format and structure for the type of information to be captured and reported. Familiarity with relational database software, mainframe capabilities, FOCUS and SQL programming is helpful and preferred. Must be able to create and maintain required databases as determined by supervisor.
• A strong understanding of physician charge practices and billing methodologies is helpful.
• Minimal travel is required. Travel may involve going to regional offices and/or conferences and exhibits.
• Staff dedicated to supporting Medicare Advantage must have working knowledge of Medicare enrollment guidelines and reimbursement.

Licenses and Certifications

• Pursuit of coding (CPC or CPHC) designation is preferred

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Serves as provider reimbursement technical advisor and/or committee participant to Information Technology staff, Benefits Administration staff, Provider Audit, Network Administration and/or Medicare Advantage staff, and entry level Reimbursement Analyst by developing and implementing project/program narratives and responding to concerns on new and existing reimbursement programs, billing guidelines, and system requirements to ensure accurate implementation and maintenance of provider reimbursement programs.
• Identifies claim