Business Analyst

University of California • Los Angeles, CA

114d • $78,500 - $163,600

About The Position

The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and external partners. This role is responsible for gathering and documenting business and system requirements, analyzing and interpreting data to support cross-functional operations, and driving system enhancements to improve efficiency and compliance. The analyst will also support testing, report generation, and documentation efforts related to software and process improvements.

Requirements

• Bachelor's Degree in Business Administration, Information Systems, Health Care or other related field required
• Minimum of five years' experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required
• Minimum of five years' experience with CMS processes in a Medicare or Managed Care environment required
• Experience with CMS processes is a plus
• Knowledge of SQL window-based computer environment including MS Office and related programs is a plus
• Knowledge of encounter regulatory reporting and compliance requirements
• Experience managing vendors to contractual requirements
• Strong ability to research and resolve encounter issues
• Strong knowledge of the health care model, capitation and other managed care IPA and provider reimbursement methodologies
• Strong knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding
• Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, and meet deadlines
• Demonstrated ability to analyze and organize complex federal and private insurance regulations
• Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools
• Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines
• Reliability and compliance with scheduling standards
• Strong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essential
• Ability to develop, implement, and evaluate methods and systems to improve efficiency
• Proven skills to lead and facilitate cross-functional workgroups and other meetings
• Ability to analyze and organize complex federal and private insurance regulations
• Must be effective at working independently with minimal supervision
• Ability to support the working hours of the department
• Ability to travel/attend off-site meetings and conferences
• Must be customer service oriented, be able to work well individually and as part of a team; and have a strong work ethic

Nice To Haves

• Experience with CMS processes
• Knowledge of SQL window-based computer environment including MS Office and related programs
• Experience managing vendors to contractual requirements

Responsibilities

• Gather and define business and technical requirements to support electronic data exchanges and system enhancements
• Collaborate across teams to design and implement effective business solutions
• Develop documentation including business cases, test cases, and process flows
• Perform data analysis and reporting to support operational decisions
• Lead and support audits, quality control initiatives, and performance improvement efforts
• Coordinate with IT and trading partners to implement Tapestry ISS and other system enhancements
• Ensure compliance with organizational policies and regulatory standards

What This Job Offers

• Industry: Educational Services
• Education Level: Bachelor's degree