For your reference, we have included the original job posting below.
Sr. Reimbursement Analyst
Job Number:
26969955
Company Name:
BlueCross BlueShield of Louisiana
Job Location:
Baton Rouge, LA US
Job Category:
Insurance
Sr. Reimbursement Analyst
Sr. Reimbursement Analyst Location: Baton Rouge, LA Company Order Number: 10-414 # of openings: 1
Description
QUALIFICATIONS:
A bachelor’s degree in statistics, accounting, finance, math or related field is required. Four years of experience in health insurance reimbursement, auditing, provider contracting, and/or financial analysis can be used in lieu of a degree. An MBA, ISDS, MHA, ASA or CPA is preferred. Pursuit of coding (CPC or CPHC) designation preferred.
In addition, one year of experience in the health industry including billing, coding, Medicare, or accounting functions or statistical analysis of financial information required. Provider contract analysis and/or reimbursement program implementation experience is strongly preferred.
Must have acquired sufficient knowledge to function autonomously and to know the appropriate contacts within departments to resolve specific issues for all lines of business.
Excellent analytical, oral and written communication, and report preparation skills with highest degree of accuracy are required. Must have the ability to effectively present information to Executive Management and all levels of employees.
Excellent attention to detail, research, and documentation skills are required.
Proficiency with commonly used database, spreadsheet and word processing software is required. Must have extensive knowledge to select the appropriate database format and structure for the type of information to be captured and reported. Familiarity with relational database software, mainframe capabilities, FOCUS and SQL programming is helpful and preferred. Must be able to create and maintain required databases as determined by supervisor.
A strong understanding of physician charge practices and billing methodologies is helpful.
Minimal travel is required. Travel may involve going to regional offices and/or conferences and exhibits.
ACCOUNTABILITIES:
Serves as provider reimbursement technical advisor and/or committee participant to Information Technology staff, Benefits Administration staff, Provider Audit, Network Administration staff, and entry level Reimbursement Analyst by developing and implementing project/program narratives and responding to concerns on new and existing reimbursement programs, billing guidelines, and system requirements to ensure accurate implementation and maintenance of provider reimbursement programs.
Identifies claims and provider reimbursement related system problems, including claims coding and processing issues, coordinates research, audit, and recommendations with Provider Audit, and implements and monitors system changes to resolve any problems.
Researches, designs, implements, and maintains complex hospital or professional provider reimbursement programs for traditional and managed care programs. Contact other plans, consultants, and local providers to assist in program specifications. Proactively monitors health care and health industry developments, including CMS/Medicare. Analyzes and produces management reports to monitor effectives and identify and resolve deficiencies of reimbursement programs in comparison to industry benchmarks, competitors, and Medicare.
Leads in the development of complex financial pricing models and financial data analysis to support modifications to reimbursement programs and monitor effectiveness of pricing logic.
Provides statistical reports to Network Administration, Medical Management, and Marketing to support internal strategies and external customer needs, such as contract negotiations and marketing efforts.
Complies with Corporate Objectives on project implementation and schedule deadlines. Ensures proper workflow by assessing reimbursement processes and recommending improvement as well as coordinating projects and time frames with less senior reimbursement staff.
This position reports to the Director, Facility Reimbursement.
