Senior Healthcare Data Analyst – Reimbursement

Job not on LinkedIn

🔥 16 hours ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟠 Senior

📉 Data Analyst

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👻 Ghost score 12%

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Blue Cross and Blue Shield of Louisiana

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1934

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross Blue Shield Association, offering a range of health insurance products and services in the state of Louisiana. The company provides health, dental, and travel insurance options, including Medicare Advantage plans such as HMO and PPO. They focus on delivering comprehensive healthcare coverage through various plans to meet varying customer needs, while partnering with doctors, hospitals, and clinics to ensure quality care and support. Additionally, the company emphasizes wellness programs, cost-saving opportunities, and accessibility for its members.

📋 Description

• Research, analyze, develop, and maintain complex reimbursement programs • Design system specifications supporting claims payment and analytical databases • Create training documentation covering programming, billing, and payment guidelines • Serve as a provider reimbursement technical advisor and/or committee participant • Develop and implement project and program narratives • Respond to concerns regarding reimbursement programs, billing guidelines, and system requirements • Identify claims and provider reimbursement system problems, including coding and processing issues • Coordinate research, audits, and recommendations with Provider Audit • Implement and monitor system changes to resolve problems • Research, design, implement, and maintain hospital and professional provider reimbursement programs for traditional, managed care, and Medicare Advantage programs • Contact plans, consultants, and local providers to assist with program specifications • Monitor healthcare and health industry developments, including CMS/Medicare eligibility, EGWP, and methodology changes • Analyze and produce management reports to monitor effectiveness and identify and resolve reimbursement deficiencies • Lead development of complex financial pricing models and financial data analysis • Provide statistical reports to Network Administration, Medical Management, Marketing, and Medicare Advantage • Comply with project implementation objectives and schedule deadlines • Assess reimbursement processes, recommend improvements, and coordinate projects and timelines with less senior reimbursement staff • Comply with applicable laws and regulations • Perform other job-related duties as assigned

🎯 Requirements

• Bachelor's degree in statistics, accounting, finance, math or related field is required, or four years of related experience in lieu of a Bachelor's degree • Four years of experience in 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 preferred • Sufficient knowledge to function autonomously and identify appropriate departmental contacts to resolve issues across all lines of business • Excellent analytical, oral and written communication, and report preparation skills with highest degree of accuracy • Ability to effectively present information to Executive Management and all levels of employees • 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 • Proficiency with commonly used database, spreadsheet and word processing software • Extensive knowledge to select appropriate database format and structure for information capture and reporting • Familiarity with relational database software, mainframe capabilities, FOCUS and SQL programming is helpful and preferred • Ability to create and maintain required databases as determined by supervisor • Strong understanding of physician charge practices and billing methodologies is helpful • Working knowledge of Medicare enrollment guidelines and reimbursement for staff supporting Medicare Advantage • Pursuit of coding (CPC or CPHC) designation is preferred • Minimal travel is required

🏖️ Benefits

• Resources to live well and be healthy • Continued learning and skill development • Professional growth opportunities • Community service opportunities • Minimal travel to regional offices and/or conferences and exhibits • Reasonable accommodations for individuals with disabilities • Smoke- and tobacco-free workplace • Background and pre-employment drug screening after an offer is extended • Drug Free Workplace