Senior Submissions Business Analyst

The Impact You Will Have

Blue Cross and Blue Shield of Minnesota is hiring a Senior Submissions Business Analyst in Eagan, MN. In this role, you will support the Submissions Team by performing data analysis, quality assurance, and regulatory submissions with a focus on accurate and complete and Medicare Advantage (MA) data. You'll collaborate with data analysts, actuaries, risk adjustment subject matter experts, other business analysts, and cross-functional teams to deliver accurate reports, resolve submission errors, and provide data-driven solutions.

This position requires expertise in healthcare data-including claims, membership, and provider information-along with hands-on experience with file sets such as 837 claim files, MAO-002 response files, and MAO-004 response files. You will also use and collaborate via Power BI dashboards and leverage expert-level SQL skills to ensure compliance and actionable insights.

Qualified candidates will have a background in healthcare data, regulatory reporting skills, and a solid grasp of risk adjustment methodologies. Essential qualifications include hands-on experience with SQL, Power BI, and Medicare Advantage encounter data submissions. Familiarity with CMS ACA EDGE, Minnesota Medicaid rejection reports, healthcare file formats, and CMS guidelines is highly valued. Strong problem-solving, communication, and collaboration abilities are crucial for guiding teams and supporting compliance in a fast-paced, regulated environment.

Your Responsibilities

• Conducts in-depth research and analysis.

• Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.

• Documents metrics and process changes.

• Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.

• Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.

• Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.

• Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.

• Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.

• Serves as senior subject matter expert associated with content, processes, and procedures.

• May lead project teams and may provide training to lower level staff to achieve project milestones and objectives.

• Required Skills and Experience

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• Advanced collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications.

• Advanced ability to communicate to all levels of management.

• Advanced research, analytical and problem solving skills.

• Advanced skills in Microsoft Excel, Word, and Access.

• Strong ability to make decisions based on analysis and business needs.

• Advanced ability to bring a different perspective to situations and challenge the status quo.

• Project management skills.

• Proven ability to work independently with guidance in only the most complex situations.

• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• Encounter Data submissions experience with a focus onMedicare Advantage strongly preferred.

• Knowledge of CMS ACA EDGE, Medicare Advantage response files (MAOs) and/or Minnesota Medicaid rejection reports.

• Experience with managed care and health care claims

• Experience creating and maintaining reporting in Power BI.

• At least 2 years of experience using SQL, use of various databases and other data sources, and performing analytics.

• Familiarity with clinical coding (ICD-10-CM) and revenue cycles.

• Bachelor's degree.

• Knowledge of managed care and health care claims preferred.