Blue Cross Blue Shield of Arizona · 1 day ago
Payment & Coding Strategist I - III (SAS Experience) (Remote- AZ)
United States
Full-time
Remote
Mid, Senior Level
3+ years expBlue Cross Blue Shield of Arizona is dedicated to inspiring health and providing a variety of health insurance products. The Payment & Coding Strategist role focuses on driving corporate reimbursement strategies and ensuring accurate coding and pricing policies for various health insurance products while integrating analytics into decision-making processes.
Financial ServicesHealth CareHealth InsuranceInsurance
Responsibilities
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
Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
Perform all other duties as assigned
Qualification
Required
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)
All Levels: 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
Ability to recognize strategic opportunities and communicate how to use data/analytics to make timely and sound decisions
Ability to define problems, collect data, establish facts, and draw valid conclusionsAbility to deal with the unpredictability of the insurance business and minimize the variance between predicted and actual outcomes
Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs
Excellent professional and interpersonal skills, including the ability to interface with senior/executive level management
Ability to analyze data and determine creative ways to present the data to tell the story
Ability to distill and communicate financial levers and impacts to non-technical audiences
Skill in prioritizing tasks and working with multiple priorities, sometimes under limited time constraints
Act with diplomacy and sensitivity with our internal and external business partners
Ability to work at a high level without supervision
Establish, contribute to and maintain a positive work environment
Strong influencing abilities to manage internal partners to accomplish key objectives and ensure promised deliverables are achieved
Management skills in an operationally changing environment, with drive for results and success based on planned objectives
Ability to engage and collaborate with team members and business stakeholders at all levels of the organization
Ability to make decisions in a timely manner, sometimes with incomplete information and under tight deadlines
Comfortable feeling ownership of the department and tackling work which may be out of scope of responsibilities
High standard of performance while pursuing aggressive goals
Principled leadership and sound business ethics
Preferred
All Levels: Experience in a healthcare analytics role for a health insurer on a team such as informatics, healthcare economics, or actuarial
All Levels: Experience developing provider reimbursement and financial impact analyses
All Levels: 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
Company
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Arizona is a non-profit company that offers health insurance and financial services.
1001-5000 employees
H1B Sponsorship
Blue Cross Blue Shield of Arizona has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
2023 (5)
2022 (2)
2021 (1)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Pam Kehaly
President and Chief Executive Officer
Recent News
Morningstar.com
2025-11-22
Morningstar.com
2025-10-30
2025-10-23
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