What are the responsibilities and job description for the Provider Quality Incentive Settlement Analyst position at Blue Cross Blue Shield of Massachusetts?
Ready to help us transform healthcare? Bring your true colors to blue.
The Provider Quality Incentive Settlement analyst supports the administration of BCBSMA’s Value Based Care contracts (AQC, PPO and Small Group contracts) through analyzing, projecting, and settling provider group performance on efficiency and/or quality incentives. The Provider Quality Incentive Settlement analyst is detail-oriented, an effective communicator, can identify and troubleshoot issues, and is able to work within firm deadlines. applicable.
***This position is eligible in the following personas: E-Worker, Mobile and Resident***
Key Accountabilities:
Maintain a portfolio of provider risk contracts across products (HMO, PPO, MA); ensure that updates to production reporting and settlement models are implemented consistent with the terms of the contract and any applicable amendments.
Track and analyze contract performance using production reporting, settlement models and/or querying claims data. Develop estimates of performance under the contracts to support the accounting, billing, financial planning, and rating processes.
Support annual provider settlement process including calculation of final quality scores as well as processing and validation of appeals and outcomes.
Support additional business processes including calculation of annual proxy scores for negotiation purposes and quarterly validation of PMI quality reporting.
Identify and explain drivers of performance changes and other model outputs.
Collaborate with Actuarial, Contracting, Accounting and/or Performance Measurement and Improvement to ensure necessary inputs are received, assumptions are correct, and results are accurate.
Coordinate the disbursement or collection of funds due under contract terms.
Support efforts to continually improve our understanding of financial and/or quality performance and the efficiency of our modeling and reporting.
Qualifications (knowledge/skills/abilities/behaviors):
Strong financial, technical, and analytic skills
Strong PC skills and software application experience required including Excel and Access. SAS/SQL experience desirable.
Ability to identify, investigate and/or escalate data and/or business issues in dynamic environment.
Broad grasp of financial/actuarial concepts in order to understand impact of settlement results and to ensure accurate payments are forecast, communicated internally and externally and are paid or received.
Ability to work independently
Attention to detail with high level of accuracy and adherence to contract terms
Support risk mitigation through documentation, knowledge sharing, and training across team functions
Strong written and oral communication skills to be applied in a variety of settings (e.g one-on-ones, presentations, group discussions)
Strong team player with customer focus
Time management and organizational skills to perform a variety of projects under specific time constraints
Education/Relevant Experience:
Professional with 1-5 years of experience as a data analyst, preferably in the healthcare industry.
Knowledge of healthcare delivery systems, provider reimbursement methodologies and provider incentive systems preferred
Bachelor’s degree required
#LI-REMOTE
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Boston Time Type Full time
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
The Provider Quality Incentive Settlement analyst supports the administration of BCBSMA’s Value Based Care contracts (AQC, PPO and Small Group contracts) through analyzing, projecting, and settling provider group performance on efficiency and/or quality incentives. The Provider Quality Incentive Settlement analyst is detail-oriented, an effective communicator, can identify and troubleshoot issues, and is able to work within firm deadlines. applicable.
***This position is eligible in the following personas: E-Worker, Mobile and Resident***
Key Accountabilities:
Maintain a portfolio of provider risk contracts across products (HMO, PPO, MA); ensure that updates to production reporting and settlement models are implemented consistent with the terms of the contract and any applicable amendments.
Track and analyze contract performance using production reporting, settlement models and/or querying claims data. Develop estimates of performance under the contracts to support the accounting, billing, financial planning, and rating processes.
Support annual provider settlement process including calculation of final quality scores as well as processing and validation of appeals and outcomes.
Support additional business processes including calculation of annual proxy scores for negotiation purposes and quarterly validation of PMI quality reporting.
Identify and explain drivers of performance changes and other model outputs.
Collaborate with Actuarial, Contracting, Accounting and/or Performance Measurement and Improvement to ensure necessary inputs are received, assumptions are correct, and results are accurate.
Coordinate the disbursement or collection of funds due under contract terms.
Support efforts to continually improve our understanding of financial and/or quality performance and the efficiency of our modeling and reporting.
Qualifications (knowledge/skills/abilities/behaviors):
Strong financial, technical, and analytic skills
Strong PC skills and software application experience required including Excel and Access. SAS/SQL experience desirable.
Ability to identify, investigate and/or escalate data and/or business issues in dynamic environment.
Broad grasp of financial/actuarial concepts in order to understand impact of settlement results and to ensure accurate payments are forecast, communicated internally and externally and are paid or received.
Ability to work independently
Attention to detail with high level of accuracy and adherence to contract terms
Support risk mitigation through documentation, knowledge sharing, and training across team functions
Strong written and oral communication skills to be applied in a variety of settings (e.g one-on-ones, presentations, group discussions)
Strong team player with customer focus
Time management and organizational skills to perform a variety of projects under specific time constraints
Education/Relevant Experience:
Professional with 1-5 years of experience as a data analyst, preferably in the healthcare industry.
Knowledge of healthcare delivery systems, provider reimbursement methodologies and provider incentive systems preferred
Bachelor’s degree required
#LI-REMOTE
Minimum Education Requirements:
High school degree or equivalent required unless otherwise noted above
Location Boston Time Type Full time
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19 or an accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
Salary : $57,100 - $72,200
Quality Analyst
Integrated Resources, Inc ( IRI ) -
Cambridge, MA
Quality Analyst & Business Analyst
MicroCoders LLC -
Woburn, MA
Sr. Quality Analyst
VITS Consulting Corp -
Boston, MA
