Louisiana Blue · 21 hours ago
Senior Reimbursement Analyst
Baton Rouge, LA
Full-time
Onsite
Mid, Senior Level
4+ years expLouisiana Blue is committed to ensuring their employees have the resources to live well and grow professionally. They are seeking a Senior Reimbursement Analyst to research, analyze, and maintain complex reimbursement programs while collaborating with various internal and external stakeholders to ensure accurate implementation and compliance with billing guidelines.
Health CareInsuranceNon Profit
Responsibilities
Serves as provider reimbursement technical advisor and/or committee participant to Information Technology staff, Benefits Administration staff, Provider Audit, Network Administration and/or Medicare Advantage staff, and entry level Reimbursement Analyst by developing and implementing project/program narratives and responding to concerns on new and existing reimbursement programs, billing guidelines, and system requirements to ensure accurate implementation and maintenance of provider reimbursement programs
Identifies claims and provider reimbursement related system problems, including claims coding and processing issues, coordinates research, audit, and recommendations with Provider Audit, and implements and monitors system changes to resolve any problems
Researches, designs, implements, and maintains complex hospital or professional provider reimbursement programs for traditional and managed care programs and Medicare Advantage. Contact other plans, consultants, and local providers to assist in program specifications. Proactively monitors health care and health industry developments, including CMS/Medicare eligibility, EGWP and methodology changes. Analyzes and produces management reports to monitor effectives and identify and resolve deficiencies of reimbursement programs in comparison to industry benchmarks, competitors, and Medicare
Leads in the development of complex financial pricing models and financial data analysis to support modifications to reimbursement programs and monitor effectiveness of pricing logic
Provides statistical reports to Network Administration, Medical Management, Marketing and Medicare Advantage to support internal strategies and external customer needs, such as contract negotiations and marketing efforts
Complies with Corporate Objectives on project implementation and schedule deadlines. Ensures proper workflow by assessing reimbursement processes and recommending improvement as well as coordinating projects and time frames with less senior reimbursement staff
Accountable for complying with all laws and regulations associated with duties and responsibilities
Perform other job-related duties as assigned, within your scope of responsibilities
Qualification
Required
Bachelor's degree in statistics, accounting, finance, math or related field is required
Four years of related experience can be used in lieu of a Bachelor's degree
4 years of experience in the health industry accounting functions including billing, coding, Medicare or statistical analysis of financial information is required
Must have acquired sufficient knowledge to function autonomously and to know the appropriate contacts within departments to resolve specific issues for all lines of business
Excellent analytical, oral and written communication, and report preparation skills with highest degree of accuracy are required
Must have the ability to effectively present information to Executive Management and all levels of employees
Requires strong math/analytical skills including variance analysis, statistical formulas, algebraic formulas, percentages, multiplication and division, fractions and reasonableness tests
Excellent attention to detail, research, and documentation skills are required
Proficiency with commonly used database, spreadsheet and word processing software is required
Must be able to create and maintain required databases as determined by supervisor
Minimal travel is required
Staff dedicated to supporting Medicare Advantage must have working knowledge of Medicare enrollment guidelines and reimbursement
Preferred
Master's Degree or pursuit of a Master's degree in Business, Information System and Decision Sciences, Healthcare Administration or Public Health
Provider contract analysis and/or reimbursement program implementation experience is strongly preferred
Familiarity with relational database software, mainframe capabilities, FOCUS and SQL programming is helpful and preferred
A strong understanding of physician charge practices and billing methodologies is helpful
Pursuit of coding (CPC or CPHC) designation is preferred
Company
Louisiana Blue
Louisiana Blue is a company on a mission: to improve the health and lives of Louisianians.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Crystal Blanchard
Account Executive
Recent News
New Orleans CityBusiness
2025-09-19
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