Healthcare Price & Transparency Analyst

Summary

Louisiana Blue is a health insurance organization seeking a Healthcare Price & Transparency Analyst. The role performs pricing and transparency reporting to support compliance with Blue Cross Association and federal mandates, while improving reimbursement operations, data processes, and analytical reporting infrastructure. The analyst collaborates with internal business areas, IT teams, and vendors to implement transparency algorithms, validate data, and enhance reporting processes.

Responsibilities

• Works closely with senior team members and the Manager, Healthcare Price and Transparency to continually refine, implement, automate, and manage the reimbursement operations strategy, focusing on the efficient, compliant and cost-effective use of existing software and applications
• Collaborates with vendors, IT and multiple cross-divisional business areas to improve reimbursement operations, solve organizational information challenges and build an efficient, effective and compliant technical analytic reporting infrastructure
• Supports the design, configuration, implementation, maintenance and documentation of transparency cost algorithms for internal and external transparency initiatives (e.g. Blue Cross Blue Shield Association's Axis system, AIM Smart Shopper, and Sapphire Digital)
• Assists in assessing reimbursement area operations, determines business requirements, identifies opportunities for improvement and assists with designing business and technology systems, recommending business process improvements, system testing, controls and protocols
• Performs other pricing and transparency related functions including, but not limited to, data transformation, data validation, reporting, and analytics to ensure compliance with Blue Cross Association and federal mandates along with meeting organizational goals

Skills

• Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support
• Bachelor's degree in a related field, preferably in health care administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or related quantitative or health care field is required
• Four years of related experience can be used in lieu of a Bachelor's degree
• 2 years of analytical experience in healthcare, IT, finance and/or other related industries required
• Must have extensive knowledge of SQL including writing queries, importing data, and creating tables and views. This includes environments such as Microsoft SQL Server, Azure Databricks and/or Snowflake
• Experience with analytic/visualization tools such as Tableau, Power BI, etc. is required
• Strong analytical and critical thinking skills are required
• Requires excellent oral and written communication skills including the demonstrated ability to present complex financial analysis and technical topics to all levels of internal staff and external vendors in a clear and understandable manner
• Extensive knowledge of Microsoft Office products including Excel (including Pivot Tables) and Power Point is required
• Requires the ability to work proficiently in a fast-paced, demanding environment
• Residency in or relocation to Louisiana is preferred for all positions
• Master's degree such as MBA, MPH, MS or MA preferred
• Basic understanding of provider payment methodologies, complex provider contracts, medical coding, clinical editing, analytic driven healthcare pricing transparency initiatives or equivalent experience is preferred
• Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. is preferred
• Medical coding designation such as CPC or CPHC is preferred

Qualifications

Must Haves

• Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support
• Bachelor's degree in a related field, preferably in health care administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or related quantitative or health care field is required
• Four years of related experience can be used in lieu of a Bachelor's degree
• 2 years of analytical experience in healthcare, IT, finance and/or other related industries required
• Must have extensive knowledge of SQL including writing queries, importing data, and creating tables and views. This includes environments such as Microsoft SQL Server, Azure Databricks and/or Snowflake
• Experience with analytic/visualization tools such as Tableau, Power BI, etc. is required
• Strong analytical and critical thinking skills are required
• Requires excellent oral and written communication skills including the demonstrated ability to present complex financial analysis and technical topics to all levels of internal staff and external vendors in a clear and understandable manner
• Extensive knowledge of Microsoft Office products including Excel (including Pivot Tables) and Power Point is required
• Requires the ability to work proficiently in a fast-paced, demanding environment

Nice to Haves

• Residency in or relocation to Louisiana is preferred for all positions
• Master's degree such as MBA, MPH, MS or MA preferred
• Basic understanding of provider payment methodologies, complex provider contracts, medical coding, clinical editing, analytic driven healthcare pricing transparency initiatives or equivalent experience is preferred
• Basic understanding of clinical and payment methodologies including per diems, APC, DRG, MPFS, CCI, etc. is preferred
• Medical coding designation such as CPC or CPHC is preferred