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Leads in the development of complex adhoc reports to enable process and trend analysis. Provides recommendations on the implementation of new/revised operational and/or reporting processes. Conducts special projects requiring a high degree of confidentiality and expert knowledge of multiple departments within the company. May provide project guidance and leadership to other Analysts.
Reports to: Senior Manager, Business Systems
Location: Chicago, IL
Background- Functional Skills required doing this job:
The Business Analyst role ensures that 100% of all encounters submitted to HFS are accepted, processed and proper reimbursement is sent back to the health plan. This position also documents and reports inappropriate adjudication trends to facilitate changes to existing claims edits, examines HFS pend and denial reports for processing inaccuracies, and completes analytical review/research with our Shared Services partners to resolve any encounter validation issues. Research claim issues to identify root cause and determine corrective action to resolve issue. Maintain documentation of issues found/resolved as a result of the research performed. Perform the adjustment of claims, including pended encounters, denied encounters, claims stuck in the Encounter portal and any other adjustment that is necessary. Enrollment and Membership Reconciliation- comparison of the 834 State file to the 820 Payment file to ensure appropriate payment. Research & Analysis for current membership algorithms related to ID Stratification, Financial Risk and Medical Expense Initiatives. Ability to conduct meetings to discuss ongoing projects and process changes.
- Develops ad-hoc reports to conduct data analysis and validation.
- Researches methodologies and conducts advanced metric reporting.
- Analyzes trends to recommend process and/or operational improvements.
- Prepares detail and summary level reports including written interpretation of analytic results.
- Presents results to management, including data-driven business recommendations and alternatives.
- Evaluates financial impact of implemented initiatives.
- Performs other duties as assigned.
- Required a Bachelor's Degree in a related field OR equivalent work experience 2 yrs. business information or analytics
- Required 5 years of experience in strong analytics, preferably in healthcare
At least two (2) years supervisory experience, preferred
At least two (2) years claim processing experience in HCFA 1500s and UB92s or Medical Claims Billing, preferred
At least (2) years or more of Computer Information Systems education preferred
- Intermediate demonstrated written communication skills
- Intermediate demonstrated interpersonal/verbal communication skills
- Intermediate ability to effectively present information and respond to questions from peers and management
- Intermediate ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Intermediate ability to work as part of a team
- Intermediate ability to work independently
- Intermediate ability to work in a fast paced environment with changing priorities
- Intermediate demonstrated organizational skills
- Intermediate ability to remain calm under pressure
- Intermediate ability to work overtime as required
- Required intermediate Microsoft Outlook
- Required intermediate Microsoft Word
- Required intermediate Microsoft PowerPoint
- Preferred intermediate Statistical Analysis Systems (SAS)
- Required advanced Microsoft Excel
- Required advanced Microsoft Access
- Preferred intermediate knowledge of PC and UNIX environments
- Preferred intermediate MS SQL
- Preferred intermediate may require knowledge of one or more of the following: SQL, Crystal, Diamond, Cognos, CRMS, Sidewinder