Business Analyst

3 weeks ago

Wilmington, North Carolina, United States Johns Hopkins Medicine Full time

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home. YOU belong here.

What awaits you:

  • Work-life balance - This is a hybrid role requiring you to work 1 day per week in the Hanover, MD office
  • Medical, Dental, and Vision Insurance.
  • 403B Savings Plan w/employer contribution.
  • Paid Time off & Paid holidays.
  • Employee and Dependent Tuition assistance benefits.
  • Health and wellness programs and MORE

As a Business Analyst in Operations, you'll:

  • Lead JHHP oversight of member and provider data, remediation work and outreach for the Medicare Advantage product.
  • Provide daily oversight of the following provider related items: provider exception report, provider file, utilization management temporary provider remediation process and LOA process. Provide daily/monthly oversight of the following member related items: MMR, TRR, FIR reports, PDE reports, CTM, appeals and grievance trending and member outreach as necessary.
  • Support the Advantage MD and Advantage MD plus programs by providing data analysis, process management, inventory management and documentation support.
    • Documentation includes business design documentation, business requirements and functional specifications and configuration mapping requirements for inbound and outbound file solutions.
  • Communicate in a timely, accurate and professional manner with all internal and external customers.
  • Plan, design, develop, and launch business, financial and operations reports in support of core organizational functions.
  • Develop and analyze large data sets to determine root cause and recommend process improvements.
  • Create/maintain reports and perform analyses for business operations and special projects.

What you'll bring:

  • 3+ years' progressively more responsible experience in a managed care environment.
  • Excellent analytical, organizational and interpersonal skills, as well as a strong background in Managed Care preferably Medicare Advantage plans and Medicare regulations.
  • Experience with MAPD enrollment experience within a health plan or related environment.
  • Knowledge of Facets and HEALTHsuite claim payment system is preferred.
  • Intermediate level ability with Excel and Access.
  • Bachelor's Degree in Business, HealthCare Management or related field preferred. Additional related work experience may substitute for some educational requirements.

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve.

Target Salary Range: Minimum 28.05 per hour - Maximum 41.17 per hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins

Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

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