Senior Submissions/Encounter Healthcare Data Analyst

The Impact You Will Have

Blue Cross and Blue Shield of Minnesota is hiring a Senior Submissions/Encounter Healthcare Data Analyst in Eagan, MN. In this role, you will support the Submissions Team by performing data analysis, quality assurance, and regulatory submissions with a focus on our government products including Affordable Care Act (ACA), Minnesota Medicaid, and Medicare Advantage (MA). You’ll collaborate with business analysts, actuaries and other cross-functional teams to deliver accurate reports, resolve risk adjustment challenges and provide data-driven solutions.

Responsibilities

• Uses databases for analysis and dissemination of information.
• Performs complex analysis of data.
• Researches, analyzes data, applies statistical methods when appropriate, and provides interpretation of outcomes.
• Identifies issues to be researched, determining affected areas, estimating the impact and contributing to the resolution.
• Implements improvements to process, analysis, and research methods.
• Works with principal positions and management to understand and interpret the impacts to cost and quality of proposals using relevant data sources and analytic methods.
• Assists in the implementation of new products and systems by providing actionable information and recommendations that evaluate the impact of the proposed products and systems.
• May represent the division on corporate projects and may have leadership roles on these teams.
• Independently manages issues that may arise on multiple tasks or projects with limited management involvement.
• Acts as a resource for other members of the department and company on business issues and may be responsible for training and guidance of other employees.

Requirements

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• 2 years experience using programming and statistical software (SQL), use of various databases and other data sources, and performing analytics.
• Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
• Ability to perform and interpret a variety of statistical analyses.
• Demonstrated ability to evaluate and interpret complex data.
• Demonstrated ability to handle multiple tasks with competing priorities.
• Demonstrated problem solving skills.
• Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to individuals and groups with varying levels of analytics expertise in a clear and concise manner.
• Demonstrated ability to present complex results and conclusions to non-technical audiences and to senior decision-makers.
• Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical, and/or clinical.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Qualifications

• Encounter Data submissions experience with a focus on ACA, Medicaid and / or Medicare Advantage strongly preferred.
• Knowledge of CMS ACA EDGE, Medicare Advantage response files (MAOs) and/or Minnesota Medicaid rejection reports.
• Experience with managed care and health care claims.
• Experience creating and maintaining reporting in Power BI or Tableau.
• High level expertise with SQL.
• Familiarity with clinical coding (ICD-10-CM) and revenue cycles.
• Bachelor's degree.

Skills

• Strong healthcare data analytics experience.
• Regulatory reporting knowledge.
• Basic familiarity with risk adjustment methodologies.
• Hands-on experience in file sets such as 837 claim files, MAO-002/04 response files, and EDGE server response files.
• Expert-level SQL skills.
• Leverage expert-level SQL skills to ensure compliance and actionable insights.

Benefits

• Pay Range: $90,800.00 - $120,300.00 - $149,800.00 Annual
• We offer a comprehensive benefits package which may include:
• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

Equal Employment Opportunity Statement

Blue Cross and Blue Shield of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.