Risk Adjustment & STARS Analyst at Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)

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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 Blue Cross.

Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana will require any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID-19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE
The Risk Adjustment and STARS Analyst provides analytics in understanding and improving the accuracy of diagnosis coding and Star Performance. In collaboration with other business areas, this position assists in problem solving, solution development and strategic planning and decision making. Accountable for complying with all laws and regulations associated with duties and responsibilities.

NATURE AND SCOPE
  • This role does not manage people
  • This job reports to: Departmental Leadership
  • Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with the following: Health Services, Actuarial, Finance, IT, Marketing, Healthcare Analytics and Data, external vendors, government entities, Blue Cross Blue Shield Association and other BCBS plan partners.


QUALIFICATIONS

Education
  • Bachelor's in healthcare administration, statistics, economics, mathematics, analytics, computer science, finance, accounting business or quantitative/healthcare related field required.
  • Four years of related experience can be used in lieu of a Bachelor's degree.
Work Experience
  • 2 years of healthcare, analytics, IT or management consulting experience
  • A master's degree in related field may substitute for two years of required experience. A doctorate degree in a related field may be substituted for an additional two years of related work experience.
Skills and Abilities
  • Must have direct experience with query/analytic/visualization tools such as SQL, SAS, Access, R, Tableau, etc.
  • Strong critical thinking, analytical and problem solving skills are required.
  • Excellent verbal and written communication skills; strong interpersonal skills. Ability to analyze, consolidate and communicate complex technical topics to all levels of internal staff and external vendors
  • Knowledge of clinical grouper (HCC, ERG, DCG, and ACG), episode groupers (ETG/MEG/Cave Grouper) and quality metrics (HEDIS, AHRQ) is highly desired.
  • Working knowledge of risk adjustment is preferred.
  • Ability to perform multiple projects in a matrix organization.
  • Ability to communicate effectively with customers with varying technical/statistical acumen.
  • Basic knowledge of United States health care delivery system in payer setting or provider setting is preferred.
Licenses and Certifications
  • Lean Six Sigma preferred


ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
  • Performs scientific and technical planning, analysis, reporting and methodological support to measure and improve medical diagnosis coding and documentation.
  • Supports leadership in reporting to assist in the planning, implementation, and measurement of coding accuracy/RADV/Stars processes.
  • Performs analytics and provides insights on Medicare Advantage STARs and coding accuracy.
  • Provides ongoing data analysis and recommends focus and direction of resources for decision makers and management that is relevant to the healthcare market; assists in problem solving, solution development, decision making, and strategic planning.
  • Hypothesizes and develops attributes that characterize or predict coding accuracy and Star Performance.
  • Leverages reporting software and models to develop attributes on population(s) and identifies opportunities to close gaps.
  • Performs peer data quality reviews, validating data and process to ensure accuracy, completeness, and consistency of department output; recommends process improvements as necessary. Investigates existing national and regional data and performs descriptive and analytic studies using basic analytical/statistical techniques.
  • Serves as technical expert advisor to collaborating departments on corporate and cross-functional projects, reports, and activities.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
  • Perform other job-related duties as assigned, within your scope of responsibilities.
  • Job duties are performed in a normal and clean office environment with normal noise levels.
  • Work is predominately done while standing or sitting.
  • The ability to comprehend, document, calculate, visualize, and analyze are required.

#LI_JH1

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to 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 [email protected] for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages 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.

Blue Cross and Blue Shield of Louisiana performs 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, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
More Information on Blue Cross and Blue Shield of Louisiana
Blue Cross and Blue Shield of Louisiana operates in the Healthtech industry. The company is located in Baton Rouge, LA. Blue Cross and Blue Shield of Louisiana was founded in 1934. It has 1803 total employees. It offers perks and benefits such as Flexible Spending Account (FSA), Disability Insurance, Dental Benefits, Vision Benefits, Health Insurance Benefits and Life Insurance. To see all 24 open jobs at Blue Cross and Blue Shield of Louisiana, click here.
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