Payment & Coding Strategist I - III (Remote- AZ)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is remote within the state of AZ only.  This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the job

Drive corporate reimbursement strategy that ensures appropriate, accurate and predictable provider reimbursement for Commercial, Medicare and Medicaid products. Ensure that coding and pricing policies are properly maintained and integrated into claims processing systems and vendor solutions. Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation.  Transform data and analytics into meaningful and actionable information. Ensure strategic alignment between HealthCare Value Advancement (HVA) projects and the organization's broader goals. Integrate analytics strategy into the execution process, including program management, project controls, communications and vendor oversight.

Qualifications

REQUIRED QUALIFICATIONS

• 3 years of experience in analytics and 3 years of experience working for a healthcare organization / health insurer  (Level 1)
• 5 years of experience in analytics and 5 years of experience working for a healthcare organization / health insurer  (Level 2)
• 7 years of experience in analytics and 7 years of experience working for a healthcare organization / health insurer  (Level 3)

• All Levels:  Bachelor’s degree in a quantitative, healthcare administrative, business, or related field of study

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PREFERRED QUALIFICATIONS

• All Levels:  Experience in a healthcare analytics role for a health insurer on a team such as informatics, healthcare economics, or actuarial
• All Levels: Experience developing provider reimbursement and financial impact analyses
• All Levels: Experience supporting code editing solutions

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ESSENTIAL job functions AND RESPONSIBILITIES

LEVEL 1

• Work with others in the department to share responsibility for all claim pricing and coding policies for Commercial, Medicare and Medicaid products. Identify potential policy changes, compile impact analyses, and present recommendations to the appropriate work group for approvals.
• Ensure that pricing and coding policies are properly maintained and integrated into claims processing systems. Work with Corporate Medical Coders to triage issues and submit change requests.
• Hold primary or backup responsibility for managing vendors that provide primary code editing, secondary code editing or other related services. Track issues, submit change requests, and manage content releases for these vendor solutions.
• Explore, analyze and implement opportunities for reimbursement policy changes that support appropria