Senior Healthcare Price and Transparency 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

Performs pricing and transparency reporting functions to ensure adherence to Blue Cross Association and federal mandates to provide members with the cost of common medical procedures, surgeries, treatments, etc. as well as quality of care information. Supports facility and professional reimbursement areas through implementation of new processes, procedures, reports, software and the refinement of existing operations. Collaborates with multiple cross-divisional business areas and vendors to improve reimbursement operations, solve organizational information challenges and build an efficient, effective and compliant technical analytical reporting infrastructure.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: Manger, Healthcare Price & Transparency
• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with: Performs pricing and transparency reporting functions to ensure adherence to Blue Cross Association and federal mandates to provide members with the cost of common medical procedures, surgeries, treatments, etc. as well as quality of care information. Supports facility and professional reimbursement areas through implementation of new processes, procedures, reports, software and the refinement of existing operations. Collaborates with multiple cross-divisional business areas and vendors to improve reimbursement operations, solve organizational information challenges and build an efficient, effective and compliant technical analytical reporting infrastructure.

QUALIFICATIONS

Education

• Bachelor's degree in a related field, preferably in health care administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or related quantitative or health care field is required.
• Master's degree such as MBA, MPH, MS or MA preferred
• Four years of related experience can be used in lieu of a Bachelor’s degree.  

Work Experience

• 4 years of experience in healthcare, analytics, IT and/or in the finance industry to include provider payment methodologies, complex provider contracts, medical coding, clinical editing, analytic driven healthcare pricing transparency initiatives or equivalent experience required.
• 2 years of experience leading analytics projects involving cross-functional teams including business operations and IT required.

Skills and Abilities

• Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. required.
• Must have extensive knowledge of SQL including writing queries, importing data, and creating tables and views. This includes environments such as Microsoft SQL Server, Azure Databricks and/or Snowflake.
• Strong experience with analytic/visualization tools such as Tableau, Power BI, etc . is required.
• Strong analytical skills, critical thinking skills and a comprehensive understanding of all aspects of healthcare financing and provider reimbursement, including industry-wide (private and governmental) payment methodologies are required.
• Requires excellent oral and written communication skills including the demonstrated ability to present complex financial analysis and technical topics to all levels of internal staff and external vendors in a clear and understandable manner.
• Extensive knowledge of Microsoft Office products including Excel (including Pivot Tables) and Power Point required.
• Requires the ability to work proficiently in a fast-paced, demanding environment.

Licenses and Certifications

• Medical coding designation such as CPC or CPHC is preferred upon hire; but must be attained within 24 months. 

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Works closely with the Manager, Healthcare Price and Transparency to continually refine, implement, automate, and manage the reimbursement operations strategy, focusing on the efficient, compliant and cost-effective use of existing software and applications.
• Collaborates with vendors, IT and multiple cross-divisional business areas to improve reimbursement operations, solve organizational information challenges and build an efficient, effective and compliant technical analytic reporting infrastructure.
• Supports the design, configuration, imp