Payment Integrity Data Analyst

Blue Cross and Blue Shield of Nebraska

2d•Hybrid

About The Position

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. The ideal candidate will live within driving distance of the Omaha, Nebraska office. This position allows remote flexibility but will be in-office for collaboration and meetings as needed. If living in one of our approved states (Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas) – this person may travel to our headquarters. The Payment Integrity (PI) Analyst (Health Data Analyst) is responsible for developing and maintaining analytics for the PI department. A PI Analyst is expected to understand PI concepts, identify data parameters to develop PI analytic data requirements, run test data for business testing and sign off, and run historical and monthly analytics concepts for overpayment identification and recovery. A PI Analyst is expected to maintain a high degree of quality and professionalism.

Requirements

Bachelor’s degree or equivalent and 5+ years’ experience in data or statistical analysis.
Advanced knowledge of SQL and data analytics.
Advanced Excel skills.
Advanced analytic skills to construct impactful findings from the extraction, manipulation and understanding of various types of data.
Mastery of Health Insurance Operations knowledge including claims, enrollment, payment mechanisms, care management, employer reporting and the ability to stay current on healthcare industry knowledge.
Successful experience working in a cross-functional environment.
Experience effectively communicating with stakeholder groups.

Nice To Haves

Proficiency working within an environment that utilizes Agile and/or Project Management techniques.
The translation of data findings into informative reports and visual outputs trusted by stakeholders to make business decisions.
Advanced experience with creating analytic models based on data trends, business program ROI, data Quality Analysis, etc.
Ability to use advanced-level calculations in the transforming of data sets into usable data.
Experience designing or building self-service content.
Ideal candidate would have experience using data manipulation tools such as R and/or Python.
Mastery of visualization best practices as well as Proficiency with visualization tools such as PowerBI and/or Tableau.
Experience with Microsoft Azure DataBricks.
Ability to translate technical requirements into business deliverables.
Skilled in navigating relationships with external partners such as vendors, providers, groups, brokers, etc.
Master's Degree in Business, Analytics, Information Technology or a Related Field.

Responsibilities

Lead the development, identification and root cause of payment accuracy opportunities through remediation with business counterparts.
Analyze provider contract trends, claims medical management data, and Enterprise data layers, as necessary to extract clean data and information for leaders and internal clients.
Utilize analytics to uncover claims payment opportunities through your knowledge of standard payment methodologies.
Verify PI savings methodologies and ensure correct savings are reported monthly for each PI capability including prepay and post pay recoveries.
Research and develop standard PI Operational Metrics to assist PI leaders to run the business.
Act as a subject matter expert to internal clients on concepts, data mining, and data analytics, especially related to product, group, network, provider, membership, and claims.
Assist PI, Claim Operations, and Finance in creating and developing PI BCBSA InterPlan billing invoices using various data sets for prepay and post pay savings.
Identify opportunities for operational and process efficiencies.
Develop understanding and balance access to multiple databases as needed to provide ad hoc reporting for PI teams.
Utilize SQL skillset to appropriately identify data resources and configure reports in a meaningful and useful way.
Document processes, sources, client requests, and reporting requests for tracking, training, and future mapping.