Job Description

About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have Blue Cross and Blue Shield of Minnesota is hiring a Senior Submissions Healthcare Data Analyst in Eagan, MN. In this role, you will support the Submissions Team by performing data analysis, quality assurance, and regulatory submissions with a focus onRisk Adjustment andMedicare Advantage (MA) data.You'llcollaborate withbusinessanalysts, actuaries andothercross-functionalteams to deliveraccuratereports, resolverisk adjustment challenges and provide data-driven solutions. This position requiresexpertisein healthcare data-including claims, membership, and provider information-along with hands-on experience in risk adjustment models, HCC analysis, RAF score calculations, andfile sets such as 837 claim files, MAO-002response files, and MAO-004response files. You will alsodevelop Power BI dashboards andleverageexpert-level SQL skills to ensure compliance and actionable insights. Candidates must have strong healthcaredata analytics experience, regulatory reporting knowledge, and familiarity with risk adjustment methodologies, combined with hands-on skills in SQL and Power BI. Encounter Data submissions experience focused onACA, Medicaid, and/orMedicare Advantage is essential. Knowledge of CMS ACA EDGE,Medicare Advantage response files (MAOs), and/or Minnesota Medicaid rejection reports is highly valued.Proficiencywith healthcare file formats, understanding of CMS guidelines, and excellent problem-solving abilities are important.Strong communicationand collaboration skills are vital for guiding teams and supporting organizational goals in a fast-paced, regulated environment. Your Responsibilities Usesdatabases for analysis and dissemination of information. Performs complex analysis of data. Researches, analyzes data, appliesstatistical methods whenappropriate, and provides interpretation of outcomes. Identifiesissues to be researched,determiningaffected areas, estimating theimpactand contributing to the resolution. Implements improvements to process, analysis, and research methods. Works with principal positions and management to understand and interpret the impactstocost and quality of proposals using relevant data sources and analytic methods. Assistsin the implementation of new products and systems by providing actionable information and recommendations that evaluate the impact of the proposed products and systems. Mayrepresentthe division on corporate projects and may have leadership roles on these teams. Independently manages issues that may arise on multiple tasks or projects with limited management involvement. Actsas a resource for other members of the department and company on business issues and maybe responsible fortrainingand guidance of other employees. Required Skills and Experience 5+ years ofrelated professionalexperience. All relevant experience including work, education, transferable skills, and military experience will be considered. 2yearsexperienceusingprogramming and statistical software (SQL),use ofvarious databases and other data sources, and performing analytics. Proficiencyin Microsoft software applications such as Word, PowerPoint, Excel, Access. Ability to perform and interpret a variety of statistical analyses. Demonstrated ability to evaluate and interpret complex data. Demonstrated ability to handle multiple tasks with competing priorities. Demonstrated problem solving skills. Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to individuals andgroups with varying levels of analyticsexpertisein a clear and concise manner. Demonstrated ability to present complex results and conclusions to non-technical audiences and to senior decision-makers. Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical, and/or clinical. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience Encounter Data submissions experience with a focus onACA, Medicaid and / orMedicare Advantage strongly preferred. Knowledge of CMS ACA EDGE, Medicare Advantageresponsefiles(MAOs) and/or Minnesota Medicaidrejection reports. Experience with managed care and health care claims Experience creating andmaintainingreporting in Power BI. High levelexpertisewith SQL. Familiarity with clinical coding (ICD-10-CM) and revenue cycles. Bachelor's degree. Knowledge of managed care and health care claimspreferred. Compensation and Benefits: Pay Range: $90,800.00 - $120,300.00 - $149,800.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We offer a comprehensive benefits package which may include: Medical, dental, and vision insurance Life insurance 401k Paid Time Off (PTO) Volunteer Paid Time Off (VPTO) And more To discover more about what we have to offer, please review our benefits page. Role Designation Hybrid Anchored in Connection Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote. Equal Employment Opportunity Statement At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com. Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.

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