Healthcare Reimbursement Analyst

Job title: Healthcare Reimbursement 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 multiple Reimbursement Analyst to join the Provider Reimbursement team, and we are open to hiring at the Associate, Analyst and Senior level depending on the experience and qualifications.

Reporting to the manager of the team, we assist Network Administration staff, Network Operations staff, Information Technology staff, Benefits Administration staff, Provider Audit staff 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, under the direction of the departmental director and working closely with more senior level reimbursement staff. Responds to ad hoc requests such as auditing of contracts, responses to RFI/RFPs, researching Medicare and other industry policies and reimbursement methodologies. Compiles fee disclosure requests and pricing of daily claim inquiries from various sources.

How You Contribute to the Organization’s Mission in this Role:

• Associate Reimbursement Analyst: This position is responsible for providing entry level analytical support in the healthcare insurance reimbursement department that is responsible for managing hospital, physician and other healthcare provider contracts governing billing and payments.

• Reimbursement Analyst: This position is responsible for providing entry to intermediate level analytical support in the healthcare insurance reimbursement department that is responsible for managing hospital, physician and other healthcare provider contracts governing billing and payments. Assists with the development, implementation, oversight, analysis and reporting of assigned reimbursement contracts including related billing, payment, and utilization of health services. Works with senior staff to design system changes, training documentation, and guidelines needed to support contractual billing, claim payments and analysis. Provides ad hoc analysis and statistical reports. Designated staff may focus primarily on supporting the Medicare Advantage line of business.

• Senior Analyst: Independently research, analyzes, develops and maintains new and existing, complex reimbursement programs. Designs system specifications that support claims payment and criteria for data bases that support analysis as well as training documentation describing programming, billing and payment guidelines for internal and external use. Designated staff may focus primarily on supporting the Medicare Advantage line of business.

Qualifications

• All Levels: Bachelor's degree in statistics, accounting, finance, mathematics, health informatics or related field is required. Excellent analytical, oral and written communication, and report preparation skills with the highest degree of accuracy are required. Proficiency with Microsoft Excel including Pivot Tables and experience with either Microsoft Access or SQL Server for building queries and statistical reports required

• Staff: 2+ years of professional financial experience, reimbursement, or analysis experience required. Experience with medical coding, interpreting, explaining, summarizing and making recommendations based upon research and statistical analysis is preferred.

• Senior: 4+ years of experience in the health industry accounting functions including billing, coding, Medicare or statistical analysis of financial information is required. Provider contract analysis and/or reimbursement program implementation experience is strongly preferred. Excellent attention to detail, research, and documentation skills are required.

• Leveling Statement

• Candidates may be considered for the Associate, Analyst, or Senior level based on the full scope of demonstrated experience and qualifications. Level placement and promotional readiness will consider SQL proficiency, analytical judgment, independence, healthcare knowledge, breadth and depth of expertise, complexity of assignments, ability to work across business areas, project leadership, technical direction, and organizational influence. Years of experience will not be the sole basis for level determination or promotion.

• An Equal Opportunity Employer

• All internal employees please apply through Workday Careers.

• Please 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 recruiting 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.