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Payment & Coding Strategist I - III

Blue Cross Blue Shield of Arizona

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Location:
United States , Phoenix

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Category:
IT - Administration

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

Drive corporate reimbursement strategy that ensures appropriate, accurate and predictable provider reimbursement for Commercial, Medicare and Medicaid products. Ensure that coding and pricing policies are properly maintained and integrated into claims processing systems and vendor solutions. Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation. Transform data and analytics into meaningful and actionable information. Ensure strategic alignment between HealthCare Value Advancement (HVA) projects and the organization's broader goals. Integrate analytics strategy into the execution process, including program management, project controls, communications and vendor oversight.

Job Responsibility:

  • Drive corporate reimbursement strategy that ensures appropriate, accurate and predictable provider reimbursement for Commercial, Medicare and Medicaid products
  • Ensure that coding and pricing policies are properly maintained and integrated into claims processing systems and vendor solutions
  • Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation
  • Transform data and analytics into meaningful and actionable information
  • Ensure strategic alignment between HealthCare Value Advancement (HVA) projects and the organization's broader goals
  • Integrate analytics strategy into the execution process, including program management, project controls, communications and vendor oversight
  • Work with others in the department to share responsibility for all claim pricing and coding policies for Commercial, Medicare and Medicaid products
  • Identify potential policy changes, compile impact analyses, and present recommendations to the appropriate work group for approvals
  • Ensure that pricing and coding policies are properly maintained and integrated into claims processing systems
  • Work with Corporate Medical Coders to triage issues and submit change requests
  • Hold primary or backup responsibility for managing vendors that provide primary code editing, secondary code editing or other related services
  • Track issues, submit change requests, and manage content releases for these vendor solutions
  • Explore, analyze and implement opportunities for reimbursement policy changes that support appropriate reimbursement goals, engaging with key business partners for final decisions
  • Work collaboratively with various business areas to provide data support, analysis, monitoring, trending, and reporting
  • Provide leadership and/or HVA representation on corporate committees, analyzing, interpreting and communicating information in formats that facilitate decisions and actions
  • Actively manage multiple aspects of cross-functional projects, identifying and driving key business decisions and gathering support across multiple divisions
  • Work with provider network and marketing to develop coding and reimbursement policy documentation for release to providers through a variety of channels (e.g. online, newsletters. etc.)
  • Build and maintain effective working relationships with internal stakeholders and key external client contacts to ensure teamwork in achieving corporate goals
  • Manage informal relationships to get things done in the absence of direct reporting lines
  • Responsible for defining and prioritizing own work, including backlog
  • Work with team leaders and management to vet, refine and prioritize new project ideas
  • Integrate HVA strategy into the execution process, including program management, project controls, communications and vendor oversight
  • Research latest developments by governmental and industry entities on the establishment of coding and reimbursement policies
  • Present findings and recommendations in written and verbal formats
  • Monitor external economic and healthcare issues affecting trends, preparing succinct, easy to understand presentations of results and conclusions
  • Communicate strategic initiatives and recommendations to various levels of senior management to support data-driven decision-making
  • Drive and execute complex and critical initiatives with minimal oversight
  • Develop multi-year strategies, priorities and roadmap for HVA goals
  • The position requires a full-time work schedule
  • Perform all other duties as assigned

Requirements:

  • 3 years of experience in analytics and 3 years of experience working for a healthcare organization / health insurer (Level 1)
  • 5 years of experience in analytics and 5 years of experience working for a healthcare organization / health insurer (Level 2)
  • 7 years of experience in analytics and 7 years of experience working for a healthcare organization / health insurer (Level 3)
  • Bachelor’s degree in a quantitative, healthcare administrative, business, or related field of study
  • Intermediate skill in database, spreadsheet, business intelligence tools, statistical, programming, and data visualization software
  • Advanced skill in mathematical concepts, interpreting data and statistics
  • Advanced analytical skills necessary to generate insights and recommendations based on available data
  • Detailed knowledge of healthcare data elements & health insurance business concepts
  • Project management skill needed to create timelines, track deliverables and progress, resolve issues, and communicate project status
  • Ability to plan, organize and carry out multiple related activities simultaneously
  • Advanced problem-solving and investigative skills
  • Excellent computer skills including Microsoft Office (Word, PowerPoint, and Excel) and SharePoint Management
  • Willingness and ability to learn new analytical programs

Nice to have:

  • Experience in a healthcare analytics role for a health insurer on a team such as informatics, healthcare economics, or actuarial
  • Experience developing provider reimbursement and financial impact analyses
  • Experience supporting code editing solutions
  • Extensive knowledge of all claim types (professional, outpatient, inpatient), code sets, and detailed claims data for all business segments (Commercial, Medicare and Medicaid)
  • Proficiency in SAS
  • Intermediate proficiency with development, testing, and management of Tableau Dashboards
  • Advanced skill in database, spreadsheet, business intelligence, statistical, and data cubing software

Additional Information:

Job Posted:
December 27, 2025

Employment Type:
Fulltime
Work Type:
Remote work
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