Payment Integrity Financial Specialist

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

2d•Onsite

About The Position

Provides advanced technical, analytical, and financial support for Payment Integrity programs through the analysis, reconciliation, monitoring, and validation of financial and operational data. This role ensures the accuracy of program payments, billings, vendor financial activity, and cost containment initiatives while delivering actionable insights that improve operational performance, financial outcomes, and regulatory compliance.

Requirements

Bachelor's degree in Healthcare, Finance, Accounting, Business Administration, or a related field; 4 years of related experience may be substituted in lieu of a degree.
2 years of healthcare industry experience in one or more of the following areas: Financial analysis, Payment integrity or reimbursement analysis, Provider contract analysis, Internal audit, and/or Value-based care programs
1 year of experience solving complex business, financial, or clinical problems through data analysis.
Experience performing financial reconciliations involving payments, invoices, billing activity, and General Ledger transactions.
Strong analytical, mathematical, and problem-solving skills with demonstrated attention to detail and accuracy.
Excellent written and verbal communication skills, including the ability to present findings and recommendations to leadership.
Advanced proficiency with Microsoft Excel and Microsoft Office applications.
Ability to analyze, interpret, reconcile, and summarize large volumes of financial and operational data.
Ability to work independently in a fast-paced, deadline-driven environment.

Nice To Haves

Certified Professional Coder (CPC) certification upon hire; required within two years of placement in the role.
Experience reviewing and validating vendor invoices, payment calculations, and financial performance guarantees.
Knowledge of healthcare claims processing systems, reimbursement methodologies, and health plan operations.
Experience with provider reimbursement reviews, including compounded drug claim reimbursement calculations.
Experience supporting Accounts Payable, Accounts Receivable, or similar financial operations.
Knowledge of internal controls, audit practices, regulatory compliance, and financial governance requirements.
Experience with relational databases, SQL, data reporting, and business intelligence tools.
Understanding of Inter-Plan Payment Integrity activities and related reporting requirements.
Proven ability to identify opportunities for process improvement, operational efficiency, and cost containment.

Responsibilities

Analyze and reconcile Payment Integrity program payments, billings, vendor invoices, and related financial transactions to ensure accuracy and compliance.
Validate vendor invoices and payments against contractual terms, expected savings, and program performance metrics.
Perform financial analysis, variance reporting, cost savings validation, and performance monitoring for Payment Integrity initiatives.
Identify discrepancies, conduct root cause analyses, and partner with internal and external stakeholders to resolve issues and improve processes.
Develop methodologies, reports, and data-driven recommendations that support operational efficiency, financial stewardship, and strategic decision-making.
Serve as a subject matter expert for Payment Integrity financial and operational data while supporting audit, compliance, and cross-functional initiatives.
Perform other job-related duties as assigned, within your scope of responsibilities.