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Details
Posted: 07-May-25
Location: Los Angeles, California
Categories:
Operations
Internal Number: 147379789
Description
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.
Key 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
Salary Range: $76,200 - $158,800/Annually
Qualifications
- 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.
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