Business Analyst

Description

The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and external partners. This role is responsible for gathering and documenting business and system requirements, analyzing and interpreting data to support cross-functional operations, and driving system enhancements to improve efficiency and compliance. The analyst will also support testing, report generation, and documentation efforts related to software and process improvements.

Key Responsibilities :

Gather and define business and technical requirements to support electronic data exchanges and system enhancements

Collaborate across teams to design and implement effective business solutions

Develop documentation including business cases, test cases, and process flows

Perform data analysis and reporting to support operational decisions

Lead and support audits, quality control initiatives, and performance improvement efforts

Coordinate with IT and trading partners to implement Tapestry ISS and other system enhancements

Ensure compliance with organizational policies and regulatory standards

Salary Range : $

78,500.- $163,600 / Annually

Qualifications

Bachelor's Degree in Business Administration, Information Systems, Health Care or other related field required

Minimum of five years' experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required

Minimum of five years' experience with CMS processes in a Medicare or Managed Care environment required

Experience with CMS processes is a plus

Knowledge of SQL window-based computer environment including MS Office and related programs is a plus

Knowledge of encounter regulatory reporting and compliance requirements.

Experience managing vendors to contractual requirements.

Strong ability to research and resolve encounter issues.

Strong knowledge of the health care model, capitation and other managed care IPA and provider reimbursement methodologies.

Strong knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding.

Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, and meet deadlines.

Demonstrated ability to analyze and organize complex federal and private insurance regulations.

Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools.

Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines.

Reliability and compliance with scheduling standards.

Strong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essential.

Ability to develop, implement, and evaluate methods and systems to improve efficiency.

Proven skills to lead and facilitate cross-functional workgroups and other meetings.

Ability to analyze and organize complex federal and private insurance regulations.

Must be effective at working independently with minimal supervision.

Ability to support the working hours of the department.

Ability to travel / attend off-site meetings and conferences.

Must be customer service oriented, be able to work well individually and as part of a team; and have a strong work ethic.