Payment Research Consultant
Blue Cross Blue Shield of Minnesota (St Paul, Minnesota)

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Job Description: Summary: This position is responsible for the processes and deliverables associated with the payment methodologies implemented by Blue Cross. The scope of this position includes the research, design, and implementation of the professional, ancillary, and allied payment strategies and methodologies utilized by Blue Cross. Accountabilities: 1. Researches, tests, selects and implements payment methodologies and tools that improve the quality, reduce cost, and influence Blue Cross? operating margin. 2. Develops mathematical models to predict the impact of proposed changes to payment methodology. Understands and interprets the financial impact of decisions made by analyzing claims cost, case mix, and unit cost related to payment design/methodology. 3. Monitors and reports the usage of payment methodologies/tools. Based on results recommends and implements improvements to process, payment methodologies and/or tools 4. Leads efforts to gather competitive intelligence around the attributes and market acceptance of new payment methodologies or combinations of payment, outcome based incentives, provider efficiencies, and benefit design. 5. Monitors Medicare, federal register, regulatory requirements, Legislative Affairs, Blue Cross Association, providers, and competitors within the health care market in areas related to cost, utilization, trend, transparency, consumerism, and payment methodologies. Provides counsel to leadership relative to these trends and related opportunities to more effectively engage employer groups, providers and/or manage unit cost. 6. Provides internal and external consulting related to payment methodologies and tools. Engages customers through relationship building and involvement, using a consultative and collaborative approach to partnering on projects. 7. Communicates customer and financial implications, expectations and project/resource requirements and deliverables to internal and/or team members. 8. Consults with customers on the development and redesign of payment methodologies, and linkage to product and benefit design 9. Independently manages, which may include directing cross functional teams 10. Maintains effective communication regarding project status, issues and priorities with Senior leadership, project owners, cross divisional stakeholders and external customers 11. Serves as a subject matter expert and assumes a mentor role related to provider payment design. 12. Represents Network Management research, analytical and evaluative approaches to internal and external audiences such as conferences, and groups of healthcare stakeholders in a way that successfully demonstrates our commitment to thorough and sound market research and evaluation principles. Required Qualifications: 1. Bachelor's degree in business, finance, marketing, economics, public policy or other relevant field. Graduate degree in health policy, health services, research, public health, or other relevant field preferred. 6. Six years relevant experience required; 7. Demonstrated in-depth knowledge of market payment methodologies required (e.g., RBRVS, DRGs, APR-DRGs, APCs, APGs ) 8. Proven high level of oral and written communication skills with the ability to communicate complex payment and financial principles both internally and externally 9. Advanced analytical skills and independent problem solving ability. Ability to think and plan in a high level strategic manner 10. Strong organization and management skills. Ability to work effectively and comfortably with senior leadership of both large and small organizations. Preferred Qualifications: 1. Experience working with payment methodologies, healthcare financial analysis strongly preferred. 2. Solid understanding of market practices and principles; experience with market research within health care environment preferred. 3. Prior project management skills preferred.

Expected Travel Time: None