About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

This position conducts market research and provides data analyses that will inform Health and Network Management related to the behavioral health market segment. The incumbent provides in-depth knowledge and guiding consultation related to current health care payment methodology, market trends among other payors and providers, value-based programs, regulatory environment, and medical and payment policy. This position also conducts analysis using a wide variety of internal and external data, develops conclusions and recommendations, and presents findings and recommendations to internal and external partners.

A Day in the Life:

• Operates as a recognized subject matter expert by proactively evaluating market trends related to payment methodologies, quality and value-based programs, and network performance related to behavioral health.
• Maintain a pulse on the market dynamics; responsible for ensuring Blue Cross remains competitive in the market, by understanding the strategy and methodologies of other payors and or providers.
• Remains current on regulatory changes that impact the behavioral health network and consults with internal partners when changes are vital to remain compliant.
• Works closely with legal departments to ensure compliance with the behavioral health regulatory environment.
• Find opportunities to improve network performance and proactively presents findings and recommendations to leadership.
• Consults and collaborates with outside vendors on proposals for the network, analyzing data and presenting findings to leadership.
• Prepares and delivers consumable information to internal and external partners on topics related to the behavioral health network.
• Delivers ad-hoc analysis as needed.

Nice to Have:

• Experience with behavioral health in a health plan or provider setting.
• Working knowledge of database tools (SQL, SAS, Oracle).

Required Skills and Experiences:

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Proven ability to perform self-guided research, investigation, and problem solving.
• Demonstrated ability to manage multiple tasks with contending priorities.
• Demonstrated ability to analyze, interpret, and synthesize information from mixed sources.
• Advanced written and verbal communication and presentation skills.
• Strong knowledge of common healthcare coding and payment methodologies (RBRVS, DRGs, CPT & ICD coding protocols, etc).
• Strong Excel skills (formulas, pivot tables, data auditing, etc)
• Working knowledge of behavioral health regulatory and compliance environment.

Make A Difference

Blue Cross 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, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.