Healthcare Reimbursement Analyst

Blue Cross and Blue Shield of Louisiana•Baton Rouge, LA

About The Position

Louisiana Blue is hiring multiple Reimbursement Analysts for its Provider Reimbursement team. Candidates may be placed at the Associate, Analyst, or Senior level based on their demonstrated experience and qualifications. The role reports to the team manager and supports accurate implementation and maintenance of provider reimbursement programs. The team works with Network Administration, Network Operations, Information Technology, Benefits Administration, and Provider Audit staff to develop and implement project and program narratives and address questions about reimbursement programs, billing guidelines, and system requirements. The position also handles ad hoc requests, including contract audits, RFI/RFP responses, research into Medicare and other industry policies and reimbursement methodologies, fee disclosure requests, and pricing daily claim inquiries. At the Associate level, the role provides entry-level analytical support for the healthcare insurance reimbursement department, which manages hospital, physician, and other healthcare provider contracts governing billing and payments. At the Analyst level, the role provides entry-to-intermediate analytical support and assists with development, implementation, oversight, analysis, and reporting for assigned reimbursement contracts, including related billing, payment, and utilization of health services. Analysts work with senior staff on system changes, training documentation, and guidelines supporting contractual billing, claim payments, and analysis, and provide ad hoc analysis and statistical reports. Some positions may primarily support the Medicare Advantage line of business. At the Senior level, the role independently researches, analyzes, develops, and maintains complex reimbursement programs. Senior Analysts design system specifications supporting claims payment and databases supporting analysis, as well as training documentation on programming, billing, and payment guidelines for internal and external use. Some positions may primarily support Medicare Advantage. Level placement and promotional readiness consider SQL proficiency, analytical judgment, independence, healthcare knowledge, breadth and depth of expertise, assignment complexity, cross-functional work, project leadership, technical direction, and organizational influence; years of experience are not the sole basis. Residency in or relocation to Louisiana is preferred. Applicants must be authorized to work in the United States without employer-sponsored immigration or other employment-based immigration support. The company is an equal opportunity employer and a drug-free, smoke- and tobacco-free workplace. Background checks and pre-employment drug screening are conducted after an offer and before hire.

Requirements

Bachelor's degree in statistics, accounting, finance, mathematics, health informatics, or a related field.
Excellent analytical, oral and written communication, and report preparation skills, with a high degree of accuracy.
Proficiency with Microsoft Excel, including Pivot Tables.
Experience with either Microsoft Access or SQL Server for building queries and statistical reports.
Staff-level candidates must have at least 2 years of professional financial, reimbursement, or analysis experience.
Senior-level candidates must have at least 4 years of experience in health industry accounting functions, including billing, coding, Medicare, or statistical analysis of financial information.
Excellent attention to detail, research, and documentation skills are required for Senior-level candidates.
Must be authorized to work in the United States without employer-sponsored immigration or other employment-based immigration support.

Nice To Haves

Experience with medical coding, interpreting, explaining, and summarizing research and statistical analysis, and making recommendations based on it.
Provider contract analysis and/or reimbursement program implementation experience is strongly preferred.
Residency in or relocation to Louisiana is preferred.

Responsibilities

Develop and implement project and program narratives related to provider reimbursement programs.
Respond to concerns about new and existing reimbursement programs, billing guidelines, and system requirements.
Support accurate implementation and maintenance of provider reimbursement programs in collaboration with relevant business and technical teams.
Respond to ad hoc requests, including contract audits and RFI/RFP responses.
Research Medicare and other industry policies and reimbursement methodologies.
Compile fee disclosure requests and price daily claim inquiries from various sources.
Assist with development, implementation, oversight, analysis, and reporting of assigned reimbursement contracts, including billing, payment, and utilization of health services.
Work with senior staff to design system changes, training documentation, and guidelines for contractual billing, claim payments, and analysis.
Provide ad hoc analysis and statistical reports.
At the Senior level, independently research, analyze, develop, and maintain complex reimbursement programs.
At the Senior level, design system specifications for claims payment, databases supporting analysis, and training documentation describing programming, billing, and payment guidelines.