Value Based Operations Analyst

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

2d • Onsite

About The Position

We are hiring a Value Based Operations Analyst to join the Value Based Operations team and are open to hiring at either the Senior Analyst or Lead Analyst level based on the selected candidate's experience, qualifications, and demonstrated competencies. Reporting to the Manager or Director, Value Based Operations, this role provides analytical, technical, operational, research, system operations, project management, and implementation support for value-based, PCMH, and ACO strategies, initiatives, and mandates. The position partners with internal teams and external vendors to support effective implementation, operational accuracy, and continuous improvement of value-based initiatives. Lead Analysts independently research, design, and manage highly complex value-based arrangements, drive system and program design, and serve as subject matter experts and mentors for the broader team.

Requirements

• Bachelor's degree in statistics, accounting, finance, math, business administration, healthcare administration, or a related field is required (four years of related experience may be used in lieu of a Bachelor's degree)
• Must demonstrate a thorough understanding of how to interpret business needs and translate them into application and operational requirements.
• Excellent organizational, mathematical, analytical, oral and written communication, and report preparation skills are required, including the ability to present complex information clearly to executive management and employees at all levels.
• Requires strong research, analytical, problem-solving, and documentation skills, including the ability to locate and extract enterprise-wide data, develop business intelligence reports, interpret results, and recommend actions.
• Strong math/analytical skills are required, including variance analysis, statistical and algebraic formulas, percentages, multiplication and division, fractions, and reasonableness tests.
• Requires advanced proficiency with Microsoft Office, including Excel Pivot Tables, and the ability to prioritize, organize, and coordinate multiple assignments under strict deadlines with minimal supervision.
• Familiarity with healthcare claims processing systems and health plan operations is required.
• 4 years of healthcare industry experience in accounting functions, financial analysis, business analysis, and/or project management is required, including at least 2 years solving business, financial, and clinical problems.
• 3 years of experience in provider contract financial analysis, reimbursement program implementation, payment administration systems, EDW, and/or claims systems is required.
• Experience working with large data sets in a DBMS, such as SQL, SAS, or Teradata, is required.
• 7 years of experience in the healthcare industry, including accounting functions, financial analysis, business analysis, and/or project management, is required and must include 2 years of experience solving business, financial, and clinical problems.
• 2 years of extensive experience using at least one of the following is required: SQL Server, Teradata, and/or SQL Server Reporting Services (SSRS), for building complex queries and statistical reports (e.g., Tableau dashboards, scorecards) and performing advanced functions (e.g., macros, triggers, stored procedures) and efficient configuration of department databases and reports.
• Advanced MS Excel experience is required.

Nice To Haves

• an MBA, MHA, or CPA is preferred.
• familiarity with BCBSA and CMS value-based program guidelines and billing methodologies, and the BCBSLA corporate projects and BCBSA mandate governance processes, is preferred.
• CPC coding designation is preferred.
• 2 years of direct business analyst experience is preferred, including experience developing scope, goals, work plans, timelines, and implementation strategies for moderate to large projects impacting stakeholders across multiple divisions.
• Experience in value-based reimbursement concepts is strongly preferred.
• Provider contract analysis and/or reimbursement program implementation experience is strongly preferred.
• Demonstrated excellence in program/system design and development is required (e.g., payment user interface design, developing BCBSA billing-compliant methodologies).

Responsibilities

• Provide analytical, technical, operational, research, system operations, project management, and implementation support for value-based, PCMH, and ACO strategies, initiatives, and mandates.
• Partner with all levels of senior and divisional management and staff in Institutional Reimbursement, Professional Reimbursement, Medical Coding, Network Operations/Administration, Health Informatics, IT, BET, Clinical Solutions, Benefits Administration, Corporate Project Management, EIM, external vendors and consultants, and the Blue Cross Blue Shield Association to support effective implementation and continuous improvement of value-based initiatives.
• Ensure accurate data submissions, departmental databases, reporting, and payment support and recommendations.
• Research healthcare industry developments, value-based care best practices, CMS initiatives, competitor activity, and other Blue Cross Blue Shield plan practices to identify impacts and recommend changes.
• Comply with all laws and regulations associated with duties and responsibilities.
• Serve as a senior advisor for value-based programs by developing methodologies, performing analysis, summarizing results, and preparing conclusions in accordance with established standards and processes.
• Recommend new programs, process improvements, and procedural changes that support operational effectiveness and value-based program goals.
• Monitor project and program progress, provide status updates, identify risks or issues, and consult with management to support successful outcomes.
• Serve as a subject matter expert for value-based program data to Information Technology, EIM, Accounting, Actuarial, Benefits Administration, Network Administration, Medicare Advantage, and entry-level Value Based Analysts.
• Analyze and reconcile value-based program payments and billings using utilization and financial data from internal and external sources.
• Operationalize and support BCBSA-mandated initiatives, and model and support new payment arrangements and process improvements for existing payment arrangements.
• Independently research, analyze, develop, implement, maintain, and monitor the performance of new and existing, very complex value-based arrangements.
• Serve as the primary technical value-based analyst for complex and/or special projects and requests.
• Design and implement system specifications that support program claims payment and criteria for databases that support analysis, as well as training documentation describing programming, billing, and payment guidelines for internal and external use.
• Lead the research, design, implementation, and maintenance of new complex value-based payment arrangements and billing methodologies and provide analytical support and guidance for Senior and entry-level Value Based Analysts.
• Calculate and coordinate value-based budget, accruals, and payments with Accounting and Actuarial, report BlueCard billing variances, and prepare ad hoc program financial reporting and program requirements for BCBSA.
• Identify value-based issues related to the provider registry, incentive payments, and ASO/BlueCard billings and standard reports; conduct data quality/integrity audits; and recommend and implement process and system changes to support departmental needs.
• Create and maintain special reports, analysis, and dashboards to support value-based operations, payments, billings, and mandated data exchange.
• Serve as lead analyst and subject matter expert on value-based projects, including BCBSA mandated semi-annual release projects, providing status updates and consulting with management to ensure successful outcomes.
• Perform other job-related duties as assigned, within your scope of responsibilities.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior