Reimbursement Analyst

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 Blue Cross.

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

POSITION PURPOSE

This position is responsible for providing entry to intermediate level analytical support in the healthcare insurance reimbursement department that is responsible for managing hospital, physician and other healthcare provider contracts governing billing and payments. Assists with the development, implementation, oversight, analysis and reporting of assigned reimbursement contracts including related billing, payment, and utilization of health services. Works with senior staff to design system changes, training documentation, and guidelines needed to support contractual billing, claim payments and analysis. Provides ad hoc analysis and statistical reports. 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, Network Operations, IT, Medical Management, Benefits Administration and Medicare Advantage. Providers, provider representatives, vendors and consultants to exchange or review program information. Other data sources are market research consultants, AMA, St. Anthony, HIAA, CMS, Blue Cross and Blue Shield Association and Blue Cross and Blue Shield Plans.

QUALIFICATIONS

Education

• Bachelor's degree in mathematics, statistics, health informatics, accounting, finance or a related field is required
• Four years of related experience can be used in lieu of a Bachelor’s degree.

Work Experience

• 2 years of professional financial, reimbursement, or analysis experience is required
• Experience with medical coding (ICD9, HCPCS, CPT4) is preferred
• Experience interpreting, explaining, summarizing and making recommendations based upon research and statistical analysis (e.g. business case study recommendations, etc.) is preferred

Skills and Abilities

• Excellent analytical, oral and written communication, and report preparation skills with the highest degree of accuracy are required.
• Must have intermediate level Excel and other Microsoft Office skills and experience with query tool such as SQL, SAS, Access, R, or similar programming languages. required

Licenses and Certifications

• None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Serves as provider reimbursement technical advisor or committee participant to Network Administration staff, Network Operations staff, Information Technology staff, Benefits Administration staff, Provider Audit staff 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, under the direction of the departmental director and working closely with more senior level reimbursement staff.
• Identifies claims and provider reimbursement related system problems, including claims coding and processing issues, and coordinates research, audit, and recommendations with Provider Audit, and implements and monitors system changes to resolve these problems, under the direction of the departmental director.
• Researches, designs, implements, and maintains moderately complex hospital or professional provider reimbursement programs, under the direction of the departmental director, within corporate objectives on project implementation and schedule deadlines. Contacts other plans, consultants, and local providers to assist in program specifications. Analyzes and produces management reports to monitor effectives and identify and resolve deficiencies of reimbursement programs in comparison to industry benchmarks, competitors, and Medicare.
• Utilizes financial pricing models and financial data analysis under the director of the department director to support modifications to reimbursement programs and assist management in identifying deficiencies and monitoring effectiveness.
• Provides statistical reports to Network Administration, Medical Management,Marketing and Medicare Advantage staff to support internal strategies and external customer needs, such as contract negotiations and marketing efforts.
• Responds to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching Medicare and other industry policies and reimbursement methodologies. Compiles fee disclosure requests and pricing of daily claim inquiries from various sources.
• Accountable for complying with all laws and regulations associated with duties and responsibilities.

Additional Accountabilities and Essential Functions

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.

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An Equal Opportunity Employer

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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 recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages 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.

Blue Cross and Blue Shield of Louisiana performs 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, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

JOB CATEGORY: Data Analytics/Warehousing, & Business Intelligence