Sr. Business Analyst, Medicare Advantage Operations
Company: Harvard Pilgrim Health Care Institute
Location: East Providence
Posted on: May 16, 2022
Job Description:
Harvard Pilgrim Health Care is currently seeking a highly
motivated individual to join our Medicare Advantage Operations team
as a Sr Business Analyst. The Senior Business Analyst is
responsible for Quarterly EOB production in accordance with CMS
regulatory guidelines, development of queries and reports to
address ad hoc and routine business needs, research, and resolution
of assigned escalated claim issues and general support for the
Stride Medicare Advantage Operations function.Job Description
- Lead the production of the Quarterly EOB process with QA
support from the Technical Program Manager to ensure timely
issuance of QEOBs in accordance with CMS regulatory requirements.
Ensures follow through and correction of any identified data
issues.Serves as the Subject Matter Expert for QEOB production and
accountable for resolution of escalated issues.
- Interpret business needs to independently and efficiently
develop Sequel queries and Excel analyses of enrollment, billing
and claim data to address time sensitive ad hoc management and
compliance requests.Prepare final reports with consideration of the
intended audience.Maintain documentation of methodology and
relevant back up information in shared department records.
- Work collaboratively with the Medicare Payment Integrity Lead
to support analysis of systemic claim issues to determine root
causes of incorrect processing and assist with resolution, as
assigned.
- Research assigned escalated claims and facilitate resolution
and provide recommendations for process improvements.Proactively
communicate potential system configuration issues to designated
staff for resolution.Submit tickets to contracted claim vendor to
request reprocessing.Facilitate updates to ika system
documentation.Maintain sufficient records of case documentation and
rationale in accordance with department procedures to support
future research needs.
- Participate in the Configuration Workgroup and other claim
resolution and system management forums, as assigned.Assists with
maintenance of JIRA documentation for systemic escalated
issues.
- Work in collaboration with the Stride Technical Program
Manager, Advantasure (ika) technical resources, Corporate
Information Management and HPHC vendor relationship managers to
support oversight of all ecosystem file transfer processes in
production.Assist the Stride Technical Program Manager with issue
resolution and documentation.
- Support other Stride Medicare Advantage Operations departmental
functions, as assigned.RequirementsEDUCATION, CERTIFICATION AND
LICENSURE:
- Bachelor's Degree in Business, Health Care Administration,
Analytics, or related field. Master's Degree preferred. EXPERIENCE
(minimum years required):
- Demonstrated experience (5 to 7 years) knowledge of managed
care industry, health insurance practices and analytics.Experience
with Medicare Advantage and CMS regulated products preferred.SKILL
REQUIREMENTS:
- Proficiency with Sequel as well as Microsoft Excel, PowerPoint,
Word, and Visio.
- Working knowledge of Medicare claim processing and general
knowledge of payment regulatory guidelines and industry
practices
- Ability to independently assess situations efficiently, make
decisions and initiate resolution; manage the details with accuracy
along with the ability to understand how work products influence or
impact the big picture.
- Ability to work independently, manage multiple priorities and
effectively prioritize tasks
- Strong interpersonal listening, verbal, and written
communication skills; approachable, problem-solving
personality.
- Resilient, collaborative, flexible, innovative.What we build
together changes our customers health for the better. We are
looking for talented and innovative people to join our team. Come
join us!Please note: As of January 18, 2022, all employees -
including remote employees - must be fully vaccinated. This
position will require the successful candidate to show proof of
full vaccination against COVID-19. Point32Health is an equal
opportunity employer, and will consider reasonable accommodation to
those individuals who are unable to be vaccinated consistent with
federal, state, and local law.About Us:Point32Health is a leading
health and wellbeing organization, delivering an ever-better health
care experience to everyone in our communities. Building on the
quality, nonprofit heritage of our founding organizations, Tufts
Health Plan and Harvard Pilgrim Health Care, we leverage our
experience and expertise to help people find their version of
healthier living through a broad range of health plans and tools
that make navigating health and wellbeing easier.At Point32Health,
we're working to reshape the world of health care by pushing past
the status quo and delivering even more to the diverse communities
we serve: more innovation, more access, more support, and healthier
lives. And we want people like you on our side to make it even
better.This job has been posted by TalentBoost on behalf of
Point32Health. TalentBoost is committed to the fundamental
principle of equal opportunity and equal treatment for every
prospective and current employee. It is the policy of TalentBoost
not to discriminate based on race, color, national or ethnic
origin, ancestry, age, religion, creed, disability, sex and gender,
sexual orientation, gender identity and/or expression, military or
veteran status, or any other characteristic protected under
applicable federal, state or local law.Req ID: R3891
Keywords: Harvard Pilgrim Health Care Institute, East Providence , Sr. Business Analyst, Medicare Advantage Operations, Professions , East Providence, Rhode Island
Didn't find what you're looking for? Search again!
Loading more jobs...