Operations Analyst

UHS•Reno, NV

About The Position

The Operation Analyst position provides support regarding standard procedures and best practices to meet business objectives. Responsible for the design, development, implementation and support of reports and/or extracts. Working with Business Leaders, subject matter experts and vendors to gather and document reporting requirements to meet business needs. Plans and executes independent, objective internal audits designed to test and confirm compliance with applicable State and Federal laws. Analyzes and understands regulatory requirements and applies identified requirements to business operations when developing and conducting compliance reviews. Monitors the progress, up to the remediation, of all deficiencies once identified. This position requires in-depth knowledge and understanding of claims processing functions. Ability to analyze and interpret fee schedules, contracts and network data entry for opportunities for data clean-up projects. This position works with multiple payers/clients as the liaison for claims issues and all other communication, Create and analyze system QA reports to ensure the integrity of the data entered into multiple systems. Supports the fulfillment of internal/external audits as required. Performs other job-related duties and projects as assigned.

Requirements

High school or equivalent. Associate degree preferred
5 years health plan operations experience or health services experience preferred
Good organization skills with ability to prioritize multiple activities in a rapidly changing environment
Excellent interpersonal, communication and organizational skills with the ability to interact with all levels of personnel within the organization.
Ability to understand from a systems level perspective the interdependence of one unit or system upon another, and how changes in any one part affect all others.
Demonstrated ability and professional concern for bringing together knowledge of operations and information needs of users.
In-depth knowledge and understanding on claims processing functions
Ability to analyze, interpret and configure annual, quarterly and monthly fee schedules, contracts and ongoing maintenance.
Ability to effectively communicate in English, both verbally and in writing.
Excellent computer skills.
Self-starter, Resourceful and able to execute projects in a fluid and fast paced environment
Good organization, management, and reporting skills
Attention to detail
Strong knowledge and experience with MS Office, MS Project, MS Visio with the ability to use these and other tools to provide meaningful analytics
Ability to effectively contribute as a team member or on individual assignments.
Must be able to work independently, providing management with status updates
Excellent analytical and problem-solving skills.
Strong customer service focus
Knowledge of operational processes within the Health Plan.
Strong negotiation and persuasion skills.
Excellent written and verbal communication skills.
Ability to interact with all levels of personnel.

Nice To Haves

Associate degree preferred
5 years health plan operations experience or health services experience preferred

Responsibilities

Provide support regarding standard procedures and best practices to meet business objectives.
Responsible for the design, development, implementation and support of reports and/or extracts.
Work with Business Leaders, subject matter experts and vendors to gather and document reporting requirements to meet business needs.
Plan and execute independent, objective internal audits designed to test and confirm compliance with applicable State and Federal laws.
Analyze and understand regulatory requirements and applies identified requirements to business operations when developing and conducting compliance reviews.
Monitor the progress, up to the remediation, of all deficiencies once identified.
Analyze and interpret fee schedules, contracts and network data entry for opportunities for data clean-up projects.
Work with multiple payers/clients as the liaison for claims issues and all other communication
Create and analyze system QA reports to ensure the integrity of the data entered into multiple systems.
Support the fulfillment of internal/external audits as required.
Perform other job-related duties and projects as assigned.