Senior Business Analyst, Claims and Vendor Data

Requirements

• Bachelor's degree required; additional experience/specialized training may be considered in lieu of degree
• 4 – 6+ years’ experience in health care healthcare industry, managed care and health plan operations, including vendor contracting and oversight required
• Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation required
• Experience in claims business process analysis, preferably in healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis required
• Experience in a hospital or managed care environment with a focus on claims data analysis, provider contracting, or decision support, especially in cost and utilization analysis required
• Understanding of NYS, CMS and Medicaid reimbursement guidelines; a working knowledge of industry coding (revenue codes, ICD 9 classifications, CPT codes, etc.). Familiarity with claim coding practices and industry issues in payment methodologies; strong problem solving, root cause analysis, critical thinking skills, and meticulous attention to detail required
• Technical knowledge of health insurance claims/Financial Recovery/Vendor Oversight required
• Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes; and to identify and interpret trends, patterns, and anomalies within complex datasets of trend information required
• Experience working with internal or external stakeholders to understand business needs and translate them into technical solutions; to manage expectations; and provide HIPAA-compliant guidance to business partners, vendors, and end-users, per industry standards for EDI protocols required
• Strong understanding of data structures, relational databases, and query logic required
• Excellent communication skills (verbal, written, presentation, collaboration, persuasion); with all types/levels of audiences; ability to influence management decisions required
• Experience in Continuous Improvement Management for Operations and process mapping/documentation required
• Energy, drive and passion for End-to-End excellence and customer experience improvement required

• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, etc.) and other data systems required

   

• Proficiency in SQL for data querying/analysis; data visualization tools such as Power BI/Tableau Reporting or similar preferred
• Ability to work collaboratively with cross-functional teams required
• Familiarity with data visualization best-practices and interactive dashboard development required
• Skilled in presenting data findings in a clear and accessible format to both technical and non-technical audiences required