Business Analyst, Senior
Blue Shield of CA, Long Beach, CA, United States
Your Role
The Payment Integrity team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. Some examples of payment integrity include validating coding rules, determining the correct party, membership eligibility, contractual adherence, and conducting root cause analysis to prevent errors. This team is responsible for over $400M+ of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments. The Senior Business Analyst will report to the Director of Payment Integrity. In this role you will collaborate with various internal teams and vendors to improve the cost of healthcare and premium cost outcomes for our Behavioral Health program.
Your Knowledge and Experience Requires a bachelor's degree or equivalent experience
Requires at least 5 years of prior relevant experience
Ability to write SQL queries from scratch to accurately pull data required
Knowledge and experience with behavioral health claims required
In depth experience with payment integrity practices and related operations preferred
Possess strong data/analytic, financial, and process experience
Experience with Facets claims processing system is desired
Your Knowledge and Experience Requires a bachelor's degree or equivalent experience
Requires at least 5 years of prior relevant experience
Ability to write SQL queries from scratch to accurately pull data required
Knowledge and experience with behavioral health claims required
In depth experience with payment integrity practices and related operations preferred
Possess strong data/analytic, financial, and process experience
Experience with Facets claims processing system is desired