Berkeley, California
San Bernardino, California
Stockton, California
San Jose, California
San Jose, California
Fullerton, California
Posted: 03-Mar-25
Location: Los Angeles, California
Internal Number: 146489291
As a member of the Medicare Advantage Operations team, Business Data Analyst is instrumental in independently developing the detailed requirements specifications according to business needs.
In this role, you will:
- work directly with and serve as the liaison between business units, external trading partners, IT teams and support teams
- ensure functional and non-functional requirements are understood and implemented consistent with the Business Data Analyst’s vision
- perform testing, design and delivery requirements
- work with the team to identify, analyze, quantify, and mitigate business risks
- collaborate with the training/development staff to deliver and update training documentation
- generate adhoc reports to support operations team as needed
This is a flex-hybrid role which will require you to be onsite as required by operational need; there are no reimbursements for travel to "home office" location. Each employee must complete a FlexWork Agreement with their manager which will outline arrangement parameters and aids both parties in fully understanding expectations. Arrangements are regularly evaluated, and are subject to termination.
Salary offers are determined based on various factors including, but not limited to, qualifications, experience, and equity. The full salary range for this position is $76,200 - $158,800 annually. The budgeted salary or hourly range that the University reasonably expects to pay for this position is approximately between $80,000 - $113,000 annually.
- Bachelor’s Degree in Business Administration, Information Systems, Health Care or other related field required
- Minimum of five (5) years’ experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required
- Minimum of five (5) 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 leadership and interpersonal skills
- Initiative, problem identification, resolution and analytical skills are essential.
- Excellent oral and written communication skills are required.
- Ability to modify and adapt operational procedures to changing operational needs
- 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 work as part of a team, collaborating with colleagues.
- 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.
- Ability to set and
manage priorities judiciously
- Excellent interpersonal skills; demonstrated ability to give and receive constructive feedback
- Ability to articulate ideas to both technical and non-technical staff
- Exceptionally self-motivated; ability to motivate and participate in a team-oriented, collaborative environment.
- Superior analytical and problem solving abilities
- Must be customer service oriented, be able to work well individually and as part of a team; and have a strong work ethic.
