Provider Reimbursement and Data Analysis Manager

Job Purpose:

Manages a team of analysts in the accurate and timely retrieval, compilation, and distribution of data reports routinely used by internal departments and customers to make critical business decisions. Analysis may include medical costs and trending for senior management, clinical measures, limited underwriting, and provider and operations-based analytics. May serve as lead of senior executive committee that analyzes medical costs and trends, assist in hospital negotiations in order to achieve network discounts, or ensure return on investment and productivity goals are met for the assigned area.

Logistics:

This position is full-time (40 hours/week, 8 hours/day) Monday - Friday in a typical office environment. This role is on-site at 4101 Percival Road in Columbia, SC. Some travel between office buildings.

What You'll Do:

• Oversees activities of analysts in the assigned area. Monitors the reporting process, and maintains area specific data. Ensures reports are completed timely and correctly.
• Responds to inquiries from customers and internal areas often working together with staff to handle requests.
• Processes complex analytic requests, typically clinical in nature. Runs and analyzes reports and statistics as needed.
• Coordinates with information systems department to implement/troubleshoot data transfer to customers.
• Participates in or leads various committees and work groups.

To Qualify for This Position, You'll Need:

Required Education:

• A Bachelor's Degree in a job-related field.

Required Work Experience:

• 5 years of progressively responsible healthcare data analysis and reporting experience.

Required Skills and Abilities:

• Excellent verbal and written communication, organizational and decision-making skills.
• Excellent presentation and analytical or critical thinking skills.
• Good judgment.
• Extensive knowledge of statistical concepts.
• The ability to use complex mathematical calculations.
• Proficient spelling, grammar, and punctuation.

Required Software and Other Tools:

• Knowledge of Microsoft Office applications.
• Excellent knowledge of mainframe systems and database design.

We Prefer You to Have:

• Expertise in Medicare and Medicaid Reimbursement:Demonstrates knowledge of reimbursement methodologies for Medicare and Medicaid.
• Proficiency in Medical Billing:Skilled in CPT and HCPCS medical billing practices.
• Claims Processing Logic:Well-versed in AMMS claims processing logic.
• Programming Knowledge:Proficient in programming languages across various software platforms, including DB2, SQL, and relational databases.
• Automation Tools:Knowledgeable in using tools such as Visual Basic and Macros to automate reporting processes.

What Blue Can Do for You:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave - the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and a healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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