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Risk Adjustment BA

2 months ago

Glen Allen, United States Saxon Global Full time
SUMMARY:

The Expert Analyst is responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. This role also coordinates projects for senior management.

RESPONSIBILITIES/TASKS:
  • Develops documentation, reports and presentations for all levels within the organization including executive leadership.
  • Collaborates with Subject Matter Experts to develop accurate documents.
  • Completes ad hoc data requests as assigned. Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions.
  • Coordinates projects and analysis for management and team.
  • Ensures complete, accurate and timely data for reporting purposes.
  • Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.
  • Researches, analyzes, identifies, and evaluates data from assigned problems to evaluate existing and potential trends and issues.
  • Possesses and maintains a comprehensive understanding and knowledge of business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and research principles/methodologies.
  • Assists in the management and monitoring of multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
  • Communicates results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.
  • Recommends and implements solutions to identified problems/root cause of issues.
  • Provides expertise and guidance to unit and corporate staff as required.
  • Represents and participates in group or committee discussions.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics or a related field. Master's degree preferred. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Five (5) years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
  • Collaborate with Subject Matter Experts to develop documents like Problem pyramids and Business hypothesis.
  • Gather requirements from the business by organizing JAD sessions, Brainstorming, and preparing questionnaires.
  • Aid the manager and product owner on the regulatory requirements and satisfy the business needs for the same.
  • Create DLEs and HLEs for the purpose of financial forecasting and effort estimation.
  • Conduct GAP and SWOT analysis on the requirements gathered from the stakeholders to reflect on the current state
  • and determining the future state of the business
  • Develop reports and presentations for all levels within the organization including executive leadership while using JIRA, Confluence and SharePoint to organize the product documentation.
  • Analyze, document, and access the correct flow of 837 claims from client to CMS. (TIBCO, 999, 277CA, MA002 and MAO004) as the claims would flow through our system.
  • Research, identify, and evaluate data from assigned issues to evaluate existing and potential trends and issues while using SQL to extract data from database
  • Work with the Quality Analysis team to assist them with thorough testing of the product enhancements.
  • Communicate results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.
  • Create prototypes and wireframes using balsamic for the team as well as the business to provide product insights.
  • Represent the product management team in business and management meeting and participate in group and committee discussions.
  • Perform core agile SAFe/Scrum duties for the team like daily standups, PI planning, Grooming, Sprint planning
  • Environment includes: Daily Scrum, MS Word, MS Excel, MS SharePoint, JIRA and Confluence, SQL, Balsamiq, MS Visio
Environment: Scrum, MS Word, MS Excel, MS SharePoint, Oracle, JIRA and Confluence, SQL, Balsamiq, MS Visio

  • Strong communication skills are required to understand, interpret, and communicate ideas.
  • Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
  • Strong knowledge of data languages such as SAS or SQL.
  • Strong analytical, organizational, planning, and problem solving skills.
  • Ability to effectively interface with employees at all levels.
  • Understand and apply statistical inference.
  • Other related skills and/or abilities may be required to perform this job.
  • Experience executing in a fast-paced environment with tight deadlines.
  • Administer and adhere to corporate and departmental policies, practices and procedures.
Required Skills : MS Suite products, SQL, Data Analysis Experience, Jira/ Confluence experience **Has to have healthcare experience
Basic Qualification :
Additional Skills : opportunity for extension of project
Background Check :Yes
Drug Screen :Yes
Notes :
Selling points for candidate :opportunity for extension of project
Project Verification Info :
Candidate must be your W2 Employee :No
Exclusive to Apex :No
Face to face interview required :No
Candidate must be local :No
Candidate must be authorized to work without sponsorship ::No
Interview times set : :No
Type of project :Project Management Office
Master Job Title :EHR/EMR Project Manager
Branch Code :Richmond