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, with Associate, Analyst, and Senior placements based on demonstrated experience and qualifications. The team supports Network Administration, Network Operations, Information Technology, Benefits Administration, and Provider Audit staff by developing and implementing project and program narratives and responding to questions about reimbursement programs, billing guidelines, and system requirements. The work helps ensure provider reimbursement programs are implemented and maintained accurately, under departmental director guidance and in collaboration with more senior reimbursement staff. The role also responds to 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 position provides entry-level analytical support to a healthcare insurance reimbursement department managing hospital, physician, and other provider contracts governing billing and payments. At the Analyst level, it provides entry- to intermediate-level support, including assistance with development, implementation, oversight, analysis, and reporting for assigned reimbursement contracts and related billing, payment, and service utilization. Analysts work with senior staff on system changes, training documentation, and guidelines, and prepare ad hoc analyses and statistical reports. Some roles may focus primarily on Medicare Advantage. At the Senior level, the analyst independently researches, analyzes, develops, and maintains complex reimbursement programs. The role designs system specifications for claims payment and databases used in analysis, and develops training documentation describing programming, billing, and payment guidelines for internal and external audiences. Some Senior roles may focus primarily on Medicare Advantage. Candidates may be considered at the Associate, Analyst, or Senior level. Placement and promotional readiness are assessed using the full scope of experience and qualifications, including SQL proficiency, analytical judgment, independence, healthcare knowledge, expertise, assignment complexity, cross-functional work, project leadership, technical direction, and organizational influence; years of experience are not the sole factor. Residency in or relocation to Louisiana is preferred. Applicants must be authorized to work in the United States without employer-sponsored immigration support.

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.
For Staff-level positions: at least 2 years of professional financial, reimbursement, or analysis experience.
For Senior-level positions: at least 4 years of experience in health-industry accounting functions, including billing, coding, Medicare, or statistical analysis of financial information.
For Senior-level positions: excellent attention to detail, research, and documentation skills.
Authorization to work in the United States without employer-sponsored immigration support.

Nice To Haves

For Staff-level positions: experience with medical coding and interpreting, explaining, summarizing, and making recommendations based on research and statistical analysis.
For Senior-level positions: 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 for provider reimbursement work.
Respond to concerns and questions about new and existing reimbursement programs, billing guidelines, and system requirements.
Help ensure accurate implementation and maintenance of provider reimbursement programs.
Provide analytical support for hospital, physician, and other healthcare provider contracts governing billing and payments.
Assist with development, implementation, oversight, analysis, and reporting of assigned reimbursement contracts and related billing, payment, and utilization.
Work with senior staff to design system changes and prepare training documentation and guidelines supporting contractual billing, claim payments, and analysis.
Prepare ad hoc analyses and statistical reports.
Research, analyze, develop, and maintain complex reimbursement programs at the Senior level.
Design system specifications for claims payment and database criteria supporting analysis.
Prepare documentation describing programming, billing, and payment guidelines for internal and external use.
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.