Senior Encounter Data Submissions Data Analyst

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

Blue Cross Blue Shield of Minnesota is hiring a Senior Encounter Data Submission Data Analyst. This position is responsible to perform highly complex technical and analytical work under limited supervision in support of developing and implementing Encounter Data submission strategic business solutions through research, audit and analysis of data related to Risk Adjustment. This position functions as a Content Expert/Business Lead on various projects and work assignments.

An ideal candidate has 5+ years of experience with healthcare claims data, healthcare, Medicare and/or risk adjustment; and who can use SQL or a similar tool to query data. This person should be able to understand and communicate both business and technical needs to help the business accomplish its strategic objectives.

A Day in the Life:

• Acts as main point of contact for the Enterprise Data Solutions Senior Data Engineer accountable for Risk Adjustment data.
• Acts as a content expert/business lead for Medicare, Medicaid, and ACA encounter data while contributing to evolving technology and process changes (including business requirements and acceptance testing) to support Risk Adjustment.
• Works closely with Business and IT counterparts to recommend solutions and resolve deficiencies related to Medicare, Medicaid, and ACA encounter data or Risk Adjustment data.
• Maintains systems, product, and end to end Risk Adjustment expertise.
• Participates and leads assigned work groups, committees, and project implementations in coordination with Enterprise Data Solutions Senior Data Engineer.
• Collaborates with business and technical support teams for Medicare, Medicaid, and ACA Risk Adjustment.
• Acts as a mentor for other individuals within the department and Enterprise.
• Responds to and resolves escalated issues by conducting in-depth research and analysis related to Medicare, Medicaid, and ACA encounter data submission.
• Identifies trends and emerging issues, develops metrics, and recommendations impacting Risk Adjustment data to ensure maximum acceptance rates at CMS or DHS.
• Effectively analyzes, designs, develops, and implements new or existing processes through reporting and documentation.
• Participates in and coordinates individual projects and related activities to ensure projects progress on schedule.
• Maintains appropriate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
• Serves as senior subject matter expert associated with content, processes, and procedures.
• Performs impact analysis, issue resolution and communication related to risk adjustment data issues that are impacting encounter data.
• Interacts with varying levels of leadership, including executives, to present information when appropriate.

Nice to Have:

• Medicare, Medicaid, and/or ACA Risk Adjustment experience strongly preferred
• Health Insurance experience preferred
• 5 years of analytical experience
• Experience translating business requirements to technical teams
• Experience working with relational databases and SQL

Required Skills and Experiences:

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Advanced collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications.
• Advanced ability to communicate to all levels of management.
• Advanced research, analytical and problem solving skills.
• Advanced skills in Microsoft Excel, Word, and Access.
• Strong ability to make decisions based on analysis and business needs.
• Advanced ability to bring a different perspective to situations and challenge the status quo.
• Project management skills.
• Proven ability to work independently with guidance in only the most complex situations.

Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.