Blue Cross and Blue Shield of Louisiana Senior Value Based Operations Analyst in Baton Rouge, Louisiana
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.
Serves as an advisor for value based programs by providing analytical, technical, operational, research, system operations, project management and/or implementation support for Payment Innovation / PCMH / ACO strategies, value based initiatives and mandates. Ensures the accurate configuration of data submissions, departmental databases, reporting and recommendations. Partners with internal staff and external vendors to successfully implement value based initiatives.
NATURE AND SCOPE
This role does not manage people
This role reports to this job: MANAGER, VALUE BASED OPERATIONS
Necessary Contacts: To do this job effectively, the incumbent is required to interact with all levels of BCBSLA Senior Management, divisional management and staff in Institutional Reimbursement, Professional Reimbursement, Medical Coding, Network Operations, Network Administration, Health Informatics, IT, BET, Clinical Solutions, Benefits Administration, Corporate Project Management team, external vendors and consultants, and Blue Cross Blue Shield Association.
Bachelors degree in statistics, accounting, finance, math, business administration, healthcare administration or related field is required
An MBA, MHA or CPA is preferred
Four years of related experience can be used in lieu of a Bachelor’s degree.
4 years of experience in the healthcare industry including accounting functions, analysis of financial information, business analysis and/or project management is required and must include 2 years of experience solving business, financial and clinical problems.
3 years of provider contract financial analysis, reimbursement program implementation and/or payment administration systems, EDW, and/or claims system experience is required; experience can run concurrently with previously noted experience requirements
2 years of direct business analyst experience; experience developing scope, goals, work plans, timelines, and implementation strategies for moderate to large projects, impacting stakeholders in multiple divisions, in a fast-paced demanding environment is preferred
Experience can run concurrently.
Healthcare financial analysis and reporting experience is preferred
Provider contract analysis and/or reimbursement program implementation experience is preferred
Skills and Abilities
Must have the ability to interpret plan/policy requirements and present viable options to management.
Must demonstrate a thorough understanding of how to interpret business needs and translate them into application and operational requirements.
Excellent organizational, mathematical, analytical, oral and written communication, and report preparation skills with highest degree of accuracy are required. Must have the ability to effectively present information to Executive Management and all levels of employees.
Excellent attention to detail, research and documentation skills are required.
Requires advanced proficiency with Microsoft Office Software including Excel Pivot Tables and experience with either Microsoft Access or SQL Server for building queries. Must have extensive knowledge in selecting the appropriate database format and structure for the type of information to be captured and reported. Must be able to create and maintain required databases as determined by manager.
Excellent analytical, problem solving, reporting and project management skills are required, including prioritizing, organizing and coordinating multiple work assignments under strict deadlines with minimal supervision.
Familiarity with Healthcare claims processing systems, and health plan operations is required in order to anticipate the impact of decisions on various areas of the organization.
Familiarity with BCBSLA corporate projects process and the BCBSA mandate governance process is preferred.
Minimal travel is required, as well as the ability to work extended hours if needed.
Licenses and Certifications
- CPC coding designation preferred
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Provides analytical support, develops methodologies, performs analysis, summarizes results and develops conclusions while adhering to established standards and processes.
Makes recommendations to support the implementation of new programs and/or process and procedure improvements.
Monitors progress of projects/programs, provides status updates and consults management to ensure successful outcomes.
Serves as the lead analyst and subject matter expert for value based programs’ data to Information Technology, EIM, Accounting, Actuarial, Benefits Administration, Network Administration and/or Medicare Advantage, and entry level Value Based Analyst.
Conducts research and monitors health care, health industry developments on best practices and initiatives from CMS, competitors, other Blue Cross Blue Shield plans and identifies impact on BCBSLA and recommends changes.
Accountable for complying with all laws and regulations associated with duties and responsibilities.
Job Specific : Value Based OperationsServes as a senior Value Based Operations advisor for Value Based program operations with providers, internal value based reporting and data questions (including but not limited to Accounting support, estimated payout calculations, support for targeted value based providers), and value based programs’ provider registry.
Job Specific: Value Based Operations – PaymentResponsible for analyzing and reconciling value based program payments and billings by leveraging utilization and financial data from various internal and external sources.Responsible for operationalizing and supporting BCBSA mandated initiatives.Responsible for modeling, operationalizing and supporting new payment arrangements and/or process improvements for existing payment arrangements.
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
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.
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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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: Insurance