What are the responsibilities and job description for the Business Analyst, Consultant position at Blue Shield of CA?
Your Role
The Payment Integrity team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. Some examples of payment integrity include validating coding rules, determining the correct party, membership eligibility, contractual adherence, and conducting root cause analysis to prevent errors. This team is responsible for over $400M of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments. The Business Analyst Consultant of Payment Integrity will report to the Director of Payment Integrity. In this role you will collaborate with various internal teams and vendors to improve cost of healthcare and premium cost outcomes.
Your Knowledge and Experience
- Requires a bachelor's degree or equivalent experience
- Requires at least 7 years of prior relevant experience
- In depth experience with payment integrity practices and related operations preferred
- Possess strong data/analytic, financial, and process experience
- Familiarity with medical claim coding standards and concepts
- SQL expertise desired
- FACETS claim processing system experience desired
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
