Business Analyst Senior - Health Services Reporting

Responsibilities:

Under the direction of the Manager, Health Services Reporting Oversight this position is primarily responsible for the creation, maintenance and data integrity of the member and provider appeals report suite.  The Business Analyst, HS Reporting must be able to organize raw data, run report queries directly from processing systems, analyze data outputs and clearly communicate results.  

• Develop and maintain standard key performance indicator reports that allow for data driven decisions.
• Identify, research and analyze data outliers and/or irregularities in departmental and interdepartmental reports. 
• Translate business requirements to technical specifications to produce prescribed report outputs. 
• Design and/or standardize the process by which member and provider appeals data is collected, trended, stored and disseminated.  
• Utilize real time reports to proactively identify potential issues to mitigate Health Plan risk. 
• Collaborate with internal and external business areas to maintain a current working knowledge of contractual, regulatory, internal and informational metrics, requirements and service levels.
• Complete frequent reviews of current reporting processes to ensure accuracy of data and identify opportunities for efficiencies. 
• Participate in projects and assess impacts to reporting; including new report development, data/rule changes, parameter/assumption modifications and process amendments. 
• Consult with stakeholders to determine appropriate course of action prior to enacting changes in reporting processes. 
• Produce accurate, timely results within departmental timeframes to meet standard and adhoc reporting needs.

Education/Experience:

• Bachelor’s Degree or Equivalent work experience required.
• 5-10 years health care experience with specific experience in claims analysis and operations.
• Ability to analyze large data sets and make defensible recommendations.
• Ability to engage and communicate with individuals at all levels.
• Demonstrated ability to lead and function autonomously and as part of a team.
• Excellent organizational, analytic and interpersonal skills required.
• General knowledge of appeals process and information flow in a managed care environment. 
• Advanced analytic and technical skills.
• Clear working knowledge of MS Office Suite (including Microsoft SQL) required. 
• Prior experience working with and analyzing large data sets. 
• Previous experience with the Jiva system preferred. 
• Previous experience with Tableau preferred. 
• NCQA and DHS State reporting knowledge preferred.
• Knowledge or ability to learn Business Intelligence tools.
• Previous Healthcare or Managed Care experience required.