BCN Financial Analyst - PFA

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: audit,analysis,reporting,analysis,performance,support,department requirements,department preferences,degree,experience,knowledge,skills


Competitive Total Compensation Package

Overview: <p>The Analyst supports reimbursement and audit reporting. Based on unit assignment may be responsible for preparation and analysis of monthly HMO Primary Care Group (PCG) financial statements and other paid claim reports for the BCN product lines, coordination with parent organization (BCBSM) to supply reports for settlement purposes or auditing of paid claims to ensure payments are made per contractual language and complicated reimbursement audits. Support Provider Affairs department by producing detailed ad-hoc reports to assist in management of PCG members or assist with other facility audits to ensure claims are paid at the contracted rate.</p>
Responsibilities: <p><strong><u>REIMBURSEMENT AND AUDIT:</u></strong></p> <ul> <li>Analyze and report to BCBSM PHA hospital payments for discounted or unique arrangements to ensure accurate settlement of claims.&nbsp;</li> <li>Analyze and audit claim payments and payment mechanisms produced by the Facets claims system.&nbsp;</li> <li>Perform fee schedule impact analysis for modeling purposes and decision making; re-price claims due to retro-active pricing updates.&nbsp;</li> <li>Analyze, research, develop and implement new reimbursement methods.&nbsp;</li> <li>Assist in User Acceptance Testing of new reimbursements to assure appropriate payouts are made.&nbsp;</li> <li>Represent department on corporate workgroups and meetings.&nbsp;</li> <li>Other duties may be assigned.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in Business Administration, Finance, Accounting, Computer Science or related field.</li> <li>Two (2) years systems analyses experience required which includes one year (1) year of medical claim systems configuration and/or pricing analyses.</li> <li>One (1) year experience using diagnosis and procedure coding systems (for example CPT, MUPC, HCPCS and ICD-9) with regard to hospital or medical claims billing and processing.</li> <li>One (1) year database management software and PC experience.</li> <li>Ability to perform detailed financial analysis, complex pricing, system research/analysis, reconciliation, provide solutions and/or develop audit reports.</li> <li>High degree of complex evaluative, analysis and problem solving.</li> <li>Advanced knowledge of Microsoft Office Suite software (Access, Excel, and Word) required Business Object and Facets preferred.</li> <li>Excellent verbal and written communication skills.</li> <li>Knowledge of HMO procedures preferred.</li> <li>Thorough understanding of managed care physician provider reimbursement and risk funding arrangements preferred.</li> <li>Detailed knowledge of claims, pricing, benefits and provider mainframe computer systems required, including BCN mainframe claims subsystem (Facets) interaction preferred.</li> <li>Knowledge of funding arrangements between BCN and IPAs preferred.</li> <li>Demonstrated knowledge of claim processing system analysis and configuration preferred.</li> <li>Other duties may be assigned.</li> </ul> <p><strong><u>DEPARTMENT REQUIREMENTS:</u></strong></p> <ul> <li>Working knowledge of health care&nbsp;Facility claims processing.</li> <li>Beginning to intermediate experience using Access concepts with the ability to pull and manipulate data.</li> <li>Beginning to intermediate working ability to summarize large volumes of data using Excel.</li> </ul> <p><strong><u>DEPARTMENT PREFERENCES:</u></strong></p> <ul> <li>Experience in claims auditing.</li> <li>Knowledge of Commercial products.</li> <li>Ability to understand how claims are billed, including reimbursement process.</li> <li>Understanding of Facets configuration.</li> <li>Financial related experience and provider contracting experience.</li> </ul>