Value-Based Operations Architect (Senior/Lead)

Louisiana Blue; Baton Rouge (LA); On-site; USD 70,000 - 110,000; Full time

Job summary

Louisiana Blue is recruiting a Value Based Operations Analyst to join the Value Based Operations team and is open to Senior Analyst or Lead Analyst level based on experience and competencies.

Responsibilities include supporting value-based strategies, ensuring accurate data submissions, and coordinating with institutional reimbursement, medical coding, IT, and vendor partners to improve program outcomes.

Qualifications

• Bachelor's degree in statistics, accounting, finance, math, business administration, healthcare administration, or a related field is required (four years of related experience may be used in lieu of a Bachelor's degree).
• An MBA, MHA, or CPA is preferred.
• Must demonstrate a thorough understanding of how to interpret business needs and translate them into application and operational requirements.
• Excellent organizational, mathematical, analytical, oral and written communication, and report preparation skills are required, including the ability to present complex information clearly to executive management and employees at all levels.
• Requires strong research, analytical, problem-solving, and documentation skills, including the ability to locate and extract enterprise-wide data, develop business intelligence reports, interpret results, and recommend actions.
• Strong math/analytical skills are required, including variance analysis, statistical and algebraic formulas, percentages, multiplication and division, fractions, and reasonableness tests.
• Requires advanced proficiency with Microsoft Office, including Excel Pivot Tables, and the ability to prioritize, organize, and coordinate multiple assignments under strict deadlines with minimal supervision.
• Familiarity with healthcare claims processing systems and health plan operations is required, and familiarity with BCBSA and CMS value-based program guidelines and billing methodologies, and the BCBSLA corporate projects and BCBSA mandate governance processes, is preferred.
• CPC coding designation is preferred. Minimal travel is required, as well as the ability to work extended hours if needed.

Responsibilities

• Provide analytical, technical, operational, research, system operations, project management, and implementation support for value-based, PCMH, and ACO strategies, initiatives, and mandates.
• Partner with all levels of senior and divisional management and staff in Institutional Reimbursement, Professional Reimbursement, Medical Coding, Network Operations/Administration, Health Informatics, IT, BET, Clinical Solutions, Benefits Administration, Corporate Project Management, EIM, external vendors and consultants, and the Blue Cross Blue Shield Association to support effective implementation and continuous improvement of value-based initiatives.
• Ensure accurate data submissions, departmental databases, reporting, and payment support and recommendations.
• Research healthcare industry developments, value-based care best practices, CMS initiatives, competitor activity, and other Blue Cross Blue Shield plan practices to identify impacts and recommend changes.
• Comply with all laws and regulations associated with duties and responsibilities.

Skills

Statistics

Data analysis

Project management

Communication

SQL experience

Education

Bachelor's degree

MBA preferred

Tools

SQL Server

SSRS

Tableau

Job description

Louisiana Blue is recruiting a Value Based Operations Analyst to join the Value Based Operations team and is open to Senior Analyst or Lead Analyst level based on experience and competencies.

Responsibilities include supporting value-based strategies, ensuring accurate data submissions, and coordinating with institutional reimbursement, medical coding, IT, and vendor partners to improve program outcomes.