Payment & Coding Strategist I - III Job at Blue Cross Blue Shield of Arizona (Phoenix)

Payment & Coding Strategist I - III

Blue Cross Blue Shield of Arizona

Location:
United States , Phoenix

Category:
IT - Administration

Contract Type:
Not provided

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

Blue Cross Blue Shield of Arizona - All Job Offers

Job Link Share:

Payment & Coding Strategist I - III

Blue Cross Blue Shield of Arizona

Location:
United States , Phoenix

Category:
IT - Administration

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
December 27, 2025

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