[Remote] Principal Business Operations Advisor

Note: The job is a remote job and is open to candidates in USA. Blue Cross NC is a health insurance company seeking a Principal Business Operations Advisor to lead the creation of new audit concepts and reimbursement policies. The role involves leveraging data analysis and strategic planning to reduce overpayments and improve payment integrity processes.ResponsibilitiesCreate new recurring and ad-hoc concepts to identify cost avoidance/overpayment opportunities using large data sets on multiple variables. Provide data, analysis and recommendations to management on all findings affecting payments; including policy, contract issues, provider errors, pricing, systems and claim processesIntegrates deep data analysis and modeling analyze complex claims, medical records, and provider contractsFocuses on shifting efforts upstream to pre-pay to reduce provider abrasion, administrative costs, and the need for retrospective recoveryProvides expertise in change management and portfolio management to align with organizational goalsWork with internal stakeholders to make any necessary technical updates to the system, policies and procedures when necessary as well as coordination of education to providers. Track and report progress of prospective and retrospective cost avoidance/overpayment recoveriesSkillsBachelor's degree or advanced degree (where required)8+ years of experience in related fieldIn lieu of degree, 10+ years of experience in related fieldPayment integrity experience in a large payer Data Mining organizationDeep knowledge of payment integrity, payment methodologies, healthcare claim lifecycle, reimbursement policiesProven analytic expertise using Microsoft Excel and Access, database query capabilities, and ability to evaluate data at all levels of detailAbility to identify patterns and anomalies in large datasetsExperience working with cross-functional areas to implement new audit strategiesProven success identifying and implementing automation opportunities (audit/workflow)Experience with lean or six sigmaExperience with Facets data is highly preferredExperience with Facets is highly preferredBenefitsThe opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the communityWork-life balance, flexibility, and the autonomy to do great workMedical, dental, and vision coverage along with numerous health and wellness programsParental leave and support plus adoption and surrogacy assistanceCareer development programs and tuition reimbursement for continued education401k match including an annual company contributionAnnual Incentive Bonus*401(k) with employer matchPaid Time Off (PTO)Competitive health benefits and wellness programsCompany OverviewIt's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. It was founded in 1933, and is headquartered in Durham, North Carolina, USA, with a workforce of 5001-10000 employees. Its website is https://www.bluecrossnc.com/.