Value Based Operations Analyst

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. We invite you to apply for a career with us.

Residency in or relocation to Louisiana is preferred for all positions.

Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.

Position Summary

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.

How You Contribute to the Organization's Mission in this Role

All Levels:

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.

Senior Analyst:

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.

Lead Analyst:

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.

Qualifications

All Levels:

• 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); an MBA, MHA, or CPA is preferred.

• 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, and 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. Minimal travel is required, as well as the ability to work extended hours if needed.

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Senior Analyst:

• 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.

• 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 working with large data sets in a DBMS, such as SQL, SAS, or Teradata, is required. Experience may run concurrently with the requirements listed above.

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Lead Analyst:

• 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.

• Experience in value-based reimbursement concepts is strongly preferred.

• 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.

• 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). Experience may run concurrently with the requirements listed above.

Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.
  

An Equal Opportunity Employer

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. 

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact [email protected] for assistance.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. 

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.