Financial Operations Analyst Lead - Payment Integrity Datamining

Elevance Health•Tampa, FL

1d•Hybrid

About The Position

The Financial Operations Analyst Lead is responsible for analyzing data and providing new processes, system enhancements and technical solutions to complex business issues. Leads and coaches staff. Manages workflow and oversees day-to-day department responsibilities. May conduct operational meetings with staff. Assists management in establishing work goals. Prepares management reports and may do budget variance. Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. Among us are care providers, engineers, data scientists, and other dedicated professionals determined to recover, eliminate and prevent unnecessary medical-expense spending.

Requirements

Requires a BA/BS in accounting or finance and a minimum of 5 years' experience in a finance/health insurance field capacity and experience with relational databases and mainframe and client server report writers; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Experience working post-pay reviews, validation, and recovery processes in the healthcare industry strong preferred.
Experience managing multiple projects in various stages to completion strongly preferred.
Experience with medical billing guidelines, and regulations preferred.
Experience with medical coding systems such as ICD, CPT, and HCPCS strongly preferred.
Claim processing experience strongly preferred.
GBD Facets or WGS experience preferred.

Responsibilities

Develops and executes complex data analysis.
Develops strategic report applications from Finance systems.
Writes queries and macros to enhance access databases and builds new databases in support of accurate balance sheet/P&L reporting.
Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms.
Interfaces with IT as needed and documents and tracks any needed system enhancements with IT management.
Documents and responds to any external audit requests.
Assists in the implementation of software releases within the Finance organization.
Ensures proper conversion or shutdown of legacy systems by developing and documenting enterprise solutions for successful transition to core processing systems.
Has technical and operational expertise.
Can commit department to deliverables on own initiative.
Uses discretion in making independent decisions.