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Business Analysis Manager

2 months ago

Sacramento, United States Stanford Health Care Full time

1.0 FTE Full time Day - 08 Hour R2439604 Remote USA 87941 Accountable Care Claim Ops Other

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.

Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview The Business Analysis Manager provides both operational support to, and analysis of, all Tapestry claims processing-related system configuration activities. The Business Analysis Manager creates, updates, tests and maintains system configuration relating to benefits, fee schedules, provider payment contracts, Division of Responsibility (DOFR) agreements and claims adjudication logic. The ACO Business Analysis Manager ensures successful configuration, integration, and accurate and timely payment of claims. Consults appropriate internal partners on issues of interpretation/clarity.

Locations Stanford Health Care

What you will do Executes world class practices of service and patient care in support of C-I-CARE standards.

Uses C-I-CARE templates and the following components for all communication with patients and staff:

CONNECT with people by calling them their proper name, or the name they prefer (Mr., Ms., Dr.)

INTRODUCE yourself and your role

COMMUNICATE what you are going to do, how long it will take, and how it will impact the patient

ASK permission before entering a room, examining a patient or undertaking an activity

RESPOND to patient’s questions or requests promptly; anticipate patient needs

EXIT courteously with an explanation of what will come next

Work closely with Information Technology team to translate benefits, DOFRs, fee schedules, provider payment contracts and associated details into system configuration parameters.

Responsible for effective management of Code Editing System (CES), to include pro-active evaluation of edit functionality/accuracy, review and functional testing of system updates.

Document code edit issues and trends and assist with problem solving and solutions. Identify recurring claims/billing errors and trends and reports them to management when necessary.

Ensure compliance with the health plan policies for complete, accurate and consistent application of benefits.

Ensure compliance with provider and health plan contractual agreements around fee schedules and DOFRs (both upstream with health plans and downstream with delegated provider groups.)

Develops processes to analyze, design, and perform user acceptance testing on benefits, DOFRs, fee schedule, and provider payment contracts.

Provides assistance to all departments on claims payment-related issues.

Develops, documents and executes user acceptance test plans for configuration testing and validate accuracy of data loaded.

Maintains detailed knowledge and understanding of the claims processing system rules relative to claims payment.

Maintain up-to-date knowledge of regulatory changes impacting configuration (e.g. ICD-10, ASC, DRG, CPT, HCPCS code updates, CMS coding rule changes, etc.)

Remain updated on all member and provider policy changes made by the health plan, Stanford Health Care Advantage, CMS and/or the State

Compile information and prepare reports and analyses of results of system configuration findings including appropriate recommendations

Assist all internal and external stakeholders with reports as requested

Act as a liaison with the Claims, Provider Relations, UHA/SHC and Patient Financial Services departments to facilitate effective communication regarding coding and billing issues.

Assist in assuring compliance with local, state, federal coding standards.

Supervises and manages business analyst(s) focused on system configuration analysis and issue resolution tasks

Delegates work to business analyst(s) and monitors performance against expectations

Ensures adequate staffing, training and tools to support functions and responsibilities of the ACO Business Analysis team

Performs other duties as assigned and participates in organization projects as assigned.

Adheres to safety, P&P’s (if applicable), HIPAA and compliance policies.

Education Qualifications High School Diploma or GED Required

Experience Qualifications Advanced skill level in Excel Required

Knowledge of and working experience with ICD-9, CPT and HCPC coding systems Required

Minimum five (5) years of experience as a configuration analyst / business analyst or five (5) years in healthcare or managed care (such as claims adjudication) with knowledge of at least two of the following: benefits, provider contracts & pricing, DOFRs, and fee schedules Required

Minimum three (3) years of experience managing a team of analysts Required

Knowledge of Epic Tapestry Modules Preferred

Required Knowledge, Skills and Abilities Knowledge of medical claims processing including interpretation of benefits, authorizations, contracts and physician reimbursement methodologies.

Ability to translate business terms into system configuration framework.

Strong collaboration skills, with emphasis on ability to work closely with and communicate with technical teams.

Ability to research complex, multi-threaded issues, develop recommendations for resolution and present to stakeholders for decision making.

Ability to gather, read, analyze, and interpret complex data and create accurate, meaningful information for data reporting and decision support.

Experience with Microsoft Office products, specifically Excel, or other reporting software required.

Experience with validating and auditing data.

Ability to manage projects, tasks and deadlines.

Ability to multi-task and thrive in a fast-paced work environment.

Ability to work independently, organize, and prioritize work assignments.

Independent decision making skills and demonstrate initiative to resolve issues.

Excellent oral and written communication skills, great organizational skills and ability to prioritize projects.

Ability to exercise good judgment.

Able to assess and coordinate departmental work flows effectively.

Ability to manage others through effective delegation, coaching and oversight

Physical Demands and Work Conditions

Physical Demands Constant Sitting.

Frequent Walking.

Occasional Standing.

Occasional Bending.

Occasional Squatting.

Occasional Climbing.

Occasional Kneeling.

Seldom Crawling.

Constant Hand Use.

Constant Repetitive Motion Hand Use.

Frequent Grasping.

Occasional Fine Manipulation.

Frequent Pushing and Pulling.

Occasional Reaching (above shoulder level).

Frequent Twisting and Turning (Neck and Waist).

Frequent Vision (Color, Peripheral, Distance, Focus).

Lifting Frequent lifting of 0 - 10 lbs.

Occasional lifting of 11 - 20 lbs.

Seldom lifting of 21 - 30 lbs.

Seldom lifting of 31 - 40 lbs.

Seldom lifting of 40+ lbs.

Carrying Frequent lifting of 0 - 10 lbs.

Occasional lifting of 11 - 20 lbs.

Seldom lifting of 21 - 30 lbs.

Seldom lifting of 31 - 40 lbs.

Seldom lifting of 40+ lbs.

Working Environment Occasional Driving cars, trucks, forklifts and other equipment.

Constant Working around equipment and machinery.

Seldom Walking on uneven ground.

Seldom Exposure to excessive noise.

Seldom Exposure to extremes in temperature, humidity or wetness.

Seldom Exposure to dust, gas, fumes or chemicals.

Seldom Working at heights.

Seldom Operation of foot controls or repetitive foot movement.

Seldom Use of special visual or auditory protective equipment.

Seldom Use of respirator.

Seldom Working with biohazards such as blood borne pathogens, hospital waste, etc..

Blood Borne Pathogens Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment

Travel Requirements 10% travel:

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care

Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in

all of

its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements. Base Pay Scale: Generally starting at $52.64 - $69.74 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

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