Business Analyst

Harbor Health

45d

About The Position

The Business Analyst, Health Plan Systems position drives business requirements, process improvements and system enhancements. Uses advanced knowledge of healthcare data, systems, and operational processes to serve as subject matter experts to support health plan growth and improvement initiatives for member enrollment and member/group billing. Maintains knowledge of regulatory requirements that impacts business direction. At the direction of the Manager of Health Plan Operations drives resolution of issues and oversees activities related to resolution of issues impacting member and group satisfaction.

Requirements

• Three or more years of experience in member enrollment and member/group along with data analysis
• 3+ years of managed care experience
• Expert knowledge of healthcare member and billing data.
• Strong data analysis skills and experience writing basic to advanced SQL.
• Strong interpersonal and communication skills
• Proficient with verbal and written presentation of complex operational information
• Prior experience in developing RFIs for vendor selection.
• Knowledgeable with CMS requirements around IFP/ACA business.
• 2+ years’ experience in developing test cases and performing UAT.
• 3+ years of IFP/ACA enrollment requirements.
• Significant working knowledge of IFP/ACA enrollment systems (i.e., Health Sherpa).
• Previous experience with the HIPAA 834 and understanding of the transaction’s syntax.

Nice To Haves

• Familiarity with Texas Department of Insurance (TDI) rules, regulations, and law.
• Experience in the Start Up phase of a health plan.
• Strong Excel and Power Point background.
• Background in vendor implementations.
• Experience in bringing an IFP/ACA product to market.

Responsibilities

• Leads and drives operational performance improvement initiatives.
• Develops, reviews, and approves business requirement documents on assigned subject matter.
• Develops test cases across multiple domains and performs/validates test cases during UAT. Documents and issues for associated vendors.
• Serves as subject matter expert in support of enrollment and member/group billing systems.
• Engages with IT, health plans, and vendor partners to resolve issues and optimize encounters performance.
• Performs root cause analysis of enrollment and member/group billing processing.
• Develop recommendations based on data and industry knowledge. Collaborates across departments to design and implement systems changes to ensure members and group high level of satisfaction.
• Analyzes data to verify outcomes of initiatives.
• Develop reports and distribute them to appropriate departments for error resolution, follow up, and performance monitoring.
• Monitors’ vendors enrollment and billing processes, contractual compliance, and SLAs
• Work with the TPA to develop business specs at the start of a technical project.
• Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work.
• Develops detailed knowledge of the functionality of the system used for enrollment and billing ACA/IFP members.

Benefits

• Opportunity to shape, develop and mentor individuals to grow their career and impact their lives.
• Collaborative and dynamic work environment
• An organization made up of people who are passionate about changing the healthcare landscape.
• Competitive salary and benefits package
• Professional development and growth opportunities
• A transparent and unique culture

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed