Senior Healthcare Price And Transparency Advisor

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. Support 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: DIRECTOR, PROFESSIONAL REIMBURSEMENT & MEDICAL CODING

• Necessary Contacts: • This role reports to this job: DIRECTOR, PROFESSIONAL REIMBURSEMENT & MEDICAL CODING

• Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:

Network Administration Management, IT Management, Benefits Administration Management, Medical Management, Medical Coding, Payment Integrity, Business Engineering Team, Project Management Office, Blue Cross Association, other health plans and software vendors in order to successfully configure and implement new and innovative payment programs that support Healthcare Reform.

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.

• Prefer a Master's degree such as MBA, MPH, MS or MA.

• Four years of related experience can be used in lieu of a Bachelor's degree.

Work Experience

• 4 years of extensive experience in healthcare, analytics and/or in the finance industry including provider payment methodologies, complex provider contracts, medical coding, clinical editing, analytic driven healthcare pricing transparency initiatives, to include the following which can run concurrently: ◦ 2 years of experience leading analytics projects involving cross-functional teams including business operations and IT. ◦ Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. ◦ Experience solving business, financial and clinical problems with the appropriate technologies and analytic methodologies. ◦ Experience evaluating processes, providing recommendations and implementing automation for analytic data. required

Skills and Abilities

• 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.

• Must have extensive knowledge of common query/analytic/visualization tools such as SQL, SAS, Access, R, Tableau, etc.

• Requires the ability to work proficiently in a fast-paced, demanding environment.

Licenses and Certifications

• In lieu of the preferred Master's degree, a Certified Public Accountant is preferred.

• 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 Director, Facility Reimbursement and Payment Integrity and the Director, Professional Reimbursement and Medical Coding 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, implementation, maintenance and documentation of transparency cost algorithms for internal and external transparency initiatives (e.g. Blue Cross Blue Shield Association's Axis system, AIM Smart Shopper, and Sapphire Digital).

• Assesses reimbursement area operations, determines business requirements, identifies opportunities for improvement and assists with designing business and technology systems, recommending business process improvements, system testing, controls and protocols.

• Supports transparency for CAA/MRF's and analyzing other payors' files

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

• Perform other job-related duties as assigned, within your scope of responsibilities.

• 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.

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An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

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.