Business Analyst, Claims

$63,800 - $79,800/Yr

Vns Healthcare - New York, NY

Full-time - Entry Level

New York, NY

About the position

The Business Analyst, Claims position at VNS Health involves working closely with management on significant projects to address the needs and challenges of managed care payors. The role focuses on gathering requirements, performing analyses, and designing systems to enhance operational, business, and clinical functions. The analyst will collaborate with project managers and business units while working under general supervision.

Responsibilities

• Maintains analysts' library of resources and develops a library of pertinent books and articles on information systems for the department.
• Develops an understanding of VNS Health Plans strategic business objectives and business unit operations along a particular health plan value stream.
• Articulates business issues and designs data collection methodologies.
• Provides data collection and analytical support to the team and monitors projects, summarizing, creating, and distributing reports as needed.
• Participates in interdepartmental work groups in support of process improvement projects.
• Assists in the design and delivery of presentations on project status and outcomes to management.
• Monitors new and existing process designs to measure operational effectiveness.
• Provides financial impact analysis for all retro compensation grids due to amendments or new published state rates.
• Acts as a liaison between the claims department, providers, and other internal departments.
• Manages workload and inventory according to departmental SLA.
• Identifies and creates global claim projects.
• Reviews claims disputes and pends within departmental SLA.
• Identifies and reports dispute trends.
• Participates in special projects and performs other duties as assigned.

Requirements

• Bachelor's Degree in Business or related discipline or equivalent work experience required.
• At least one year of experience with a managed care organization on business transformation required.
• Two years experience using FACETS, SQL scripts & queries, OBIEE, Power BI, Tableau & MicroStrategy reports & dashboards preferred.
• Experience with project management & SDLC methodologies, contracting, and new business management across relational databases, using Oracle, SQL Server & DB2 preferred.
• Strong command of Microsoft Office Tools (Word, Excel, Visio, and PowerPoint) required.
• Effective oral and written communication skills, consulting and analytical skills required.
• Ability to function autonomously and collaborate with senior level leaders required.
• Demonstrated understanding of NYS, CMS and Medicaid reimbursement guidelines, APG, APC, DRG required.

Nice-to-haves

• Master's Degree in Business Administration, Public Administration or related field preferred.

Benefits

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, including Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities.