Senior or Lead Value Operations Analyst

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.

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.

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.

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.

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 Blue Card 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/Blue Card 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…