Payment Integrity Data Analyst
Blue Cross and Blue Shield of Nebraska
- United States
- United States
Über
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. To Be Considered For This Position, You Must Have
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. The Strongest Candidates For This Position Will Also Possess
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. Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.
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Sprachkenntnisse
- English
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