<strong>This position can be located REMOTELY across the U.S. </strong>
The Senior Analyst is an analytical role responsible to coordinate the development and implementation of Provider Delegated Groups with our Health Plan Clients. Senior Analyst ensures all Health Plan operational activities including Claims Routing and Payment and assignment of Members to Provider Delegated Groups is essential to the effectiveness of the Program. Responsibilities includes identifying opportunities to improve performance of program through process review activities.
<ul> <li> Researches and monitor performance of Provider Delegated activities through data analysis </li> <li> Performs claim reconciliations of claims processed by Provider Groups contracted with Health Plan Clients </li> <li> Proactively Develops and improves work flows and business processes within area(s) to improve customer service, decrease operational costs, and improve overall quality. </li> <li> Identifies and/or analyzes business problems and devise procedures for solutions to the problems. </li> <li> Effectively leads projects in order to produce desired results. </li> <li> Responsible for corporate communication of project results. </li> <li> Recommends and assists with implementing standard policies and procedures. </li> <li> Assures that corporate compliance is communicated, implemented, and monitored on an ongoing basis. </li> <li> Participates in systems testing, develops procedures/controls, and provides recommendations for the ongoing improvement of the updated process. </li> <li> Assists personnel (both internal and external) by answering questions, supplying information, and training. </li> <li> Develops and maintains an effective working relationship with customers. </li> <li> Participates in group or committee discussions. </li> </ul>
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
Bachelor's degree in a related field. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
Two (2) to four (4) years' experience in related field. Analyst experience required with proven experience in operational analysis, data analysis, and problem resolution type activities.
<strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: </strong>
<ul> <li> Health plan administration experience, in particular Medicare Advantage (MA) or other government-funded programs. </li> <li> Knowledge of Global and Shared Risk Capitation models such as IPA, PHO </li> <li> Experience with Delegated Provider Arrangements such as delegation of claims payment and medical management. </li> <li> Experience with Division of financial Responsibility between health plan and physician organization </li> <li> Analytical, organizational, planning and problem solving skills </li> <li> Understanding and knowledge of the business, products, programs, corporate organizational structure (including functional responsibilities), and basic research principles/methodologies </li> <li> Ability to plan, organize, direct, and control projects. </li> <li> Excellent written and verbal communication skills. </li> <li> Ability to lead and contribute to process improvement projects. </li> <li> Ability to read and interpret documents such as data flows, process flows, technical diagrams, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. </li> <li> Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. </li> <li> Administer and adhere to corporate and departmental policies, practices and procedures. </li> </ul>
Work is performed in an office setting with no unusual hazards.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.