Senior Health Data Analyst

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.

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

NATURE AND SCOPE

• This role does not manage people

• This role reports to this job: Director, Pharmacy Operations

• Necessary Contacts: All levels of BCBSLA personnel.

QUALIFICATIONS

Education

• A Bachelor's degree in Information Management Systems, Computer Science, Accounting, Mathematics, or a related field is required.

• A Master's degree in Business Administration, ISDS, MHA, ASA, Accounting, or related is preferred.

• Four years of related experience can be used in lieu of a Bachelor's degree.

Work Experience

• 4 years of experience providing operational, data, statistical, and/or financial reporting required.

• 4 years of creating/building queries and reports, performing data manipulation, analysis, and executing ad hoc reporting in a relational database management system (SQL Server, Teradata, etc.) required.

• Experience in the health insurance and prescription drug industries is preferred.

• Experience can run concurrently.

• Must have experience in three or more of the following software applications Microsoft Access, Microsoft Excel, Tableau, SQL Server, SQL Server Management Studio (SSMS), Microsoft Visual Studio, and Microsoft SQL Server Reporting Services (SSRS). Experience must include building complex queries, ad hoc reports, and statistical reports (e.g., dashboards, scorecards, etc.) and performing advanced functions within these applications (e.g., macros, triggers, stored procedures, and the efficient and effective configuration of departmental databases reports, etc.).

• Must have experience collaborating, negotiating, and facilitating a dialogue between interested parties (e.g., vendors, other internal departments) to ensure efficient, effective, and accurate data is available for the use of analysts on one's team.

• Adobe Creative Suite, Microsoft Power BI, Microsoft Project and SharePoint experience preferred.

• Must have experience working with prescription drug and/or medical data. Experience in both is preferred.

Skills and Abilities

• The employee must have extensive knowledge in selecting the appropriate database format and structure for the type of information to be captured and reported.

• Must be able to create and maintain required databases as determined by supervisor.

• Must have acquired sufficient knowledge to function autonomously and to work with appropriate contacts within departments to resolve specific issues for all lines of business.

• Excellent analytical, research, documentation, data validation and report preparation skills with the highest degree of accuracy and attention to detail are required.

• Familiarity with relational database software, mainframe capabilities, and SQL programming is helpful and preferred.

• Ability to develop clear and concise management summaries and recommendations to management that are supported by the analytics in the summaries required.

• The employee must have strong oral and written communication skills, strong public speaking and interpersonal skills, and the ability to effectively present information to all levels of employees including the Executive Management Team.

• Basic knowledge of insurance claims, provider charge practices, and billing methodologies is preferred.

• Minimal travel is required. Travel may involve going to regional offices and/or conferences and exhibits.

Licenses and Certifications

• Certified Professional Coder - Payor (CPC-P) certification preferred.

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Serves as a resource and adviser for Pharmacy business processes, systems, and data. Provides leadership, guidance, and instruction to Pharmacy, EIM/EDW, Health Analytics (Informatics), IT, and team members on using prescription drug data generally and, more specifically, enterprise and Pharmacy data repositories housing pharmacy and related prescription drug data.

• Represents Pharmacy department and provides input, advice, and guidance on the form, format, and transmission of data between Pharmacy and external parties, including vendors.

• Works with Lead Health Data Analyst and Lead Software Engineer on the development of strategies for prescription drug data acquisition, database implementation, and maintenance.

• Monitors pharmacy program performance through the development of utilization reports, comparison to industry standards and contractual agreements. Identifies areas of weakness and develops program modifications to address weakness.

• Supports the management of data migrations, conversions, data integration, and transmissions for the Pharmacy Department. Analyzes data integration requirements and creates integration solutions that support application development efforts. Modifies and implements database integration solutions to support business requirements.

• Independently and comprehensively develops data validation tools, data quality test plans and techniques, and executes all quality control processes (e.g., queries, test scenarios, etc.) to ensure accuracy of data, reports, and file extracts and to ensure compliance with departmental and corporate expectations.

• Assists Lead Health Data Analyst on Pharmacy Department Budget annual financial estimates and periodic updates as needed. Responsible for ensuring the integrity and accuracy of the data used to calculate budget estimates. Responsible for providing Pharmacy Department Vice President with comprehensive budget planning analysis.

• Manages PBM claims invoicing process, as well as other invoicing processes, as needed.

• Responds to audit questions and demands, including annual MAR Audit process.

• Leads the Pharmacy Department's annual RADV responsibilities.

• Responds to requests from the Legal department in support of normal operations and class action litigation.

• Undertakes and/or informs financial modeling and analysis to answer complex questions leading to Departmental decisions on formulary changes, vendor selection, and risk management when required.

• As needed, provides support on the data analytic and reporting component of the Medical Rebates Program. Guide EIM/EDW, Health Analytics, and IT on the creation of medical drug data extracts to be in compliance with medical rebates contract requirements; to be accurate; to be de-identified, re-identified (where necessary), and transmitted appropriately, in compliance with rebate contracts and in compliance with BCBSLA corporate policies.

• Supports Pharmacy Department Quality Assurance process for the Medical Rebates Program.

• Works with Lead Health Data Analyst and Lead Software Engineer to design system specifications that support pharmacy program claim payment and criteria for databases that support analysis for internal and external use.

• Develops special statistical reports, analyzes and interprets data, reviews systems, and makes recommendations to support the implementation of new pharmacy programs.

• Independently writes programs and executes custom reports of prescription drug data to support internal strategies, to monitor effectiveness of prescription drug programs and formulary decisions, to provide oversight vendors, and to forecast program outcomes for planning and budgeting of resources. Delivers complex and cumbersome data results in an easily digestible format through the use of data visualization, charting, and statistical techniques.

• Creates audit reports to ensure vendor contractual compliance (discounts, dispense fees for brand, generic and specialty drugs, QPD compliance, rebates, etc.), for the purpose of monitoring, and detecting, and resolving errors in pharmacy claims adjudication, and billing and rebate payments to BCBSLA.

• Identifies, researches, and assesses Pharmacy data requirements and recommends and coordinates implementation of processes and enhancements to existing processes to maintain data integrity and support ongoing Pharmacy operations.

• Accountable for complying with all laws and regulations associated with duties and responsibilities.

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.

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 ~~~ 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.

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