Strategic Business Operations Specialist

7 days ago


Denver, Colorado, United States Evolent Health Full time
About Evolent Health

Evolent Health partners with health plans and providers to achieve better outcomes for individuals with complex and costly health conditions. We work across specialties and primary care to connect the pieces of the fragmented healthcare system, ensuring people receive the same level of care and compassion as we would for our loved ones.

We believe that people do their best work when supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's why diversity and inclusion are core to our business.

Job Summary

This role spearheads requirements management for implementation projects across our client and Evolent organizations, driving our value-based strategy with partners and contributing to dynamic initiatives that propel the growth of our department and team.

Key Responsibilities
  • Clearly define requirements, process flows, use cases, and acceptance criteria for CMS and Commercial programs.
  • Facilitate communication between business/IT teams, developers, and external stakeholders.
  • Identify, document, and analyze discrepancies and anomalies within automated data reconciliation and disputed data.
  • Document business and system requirements standards when new system enhancements or engineering changes are required, maintaining standard templates and supporting ongoing maintenance.
  • Develop a deep understanding of end-user outputs, platform development & configuration, multisystem functional requirements, business rules, and leverage that knowledge to improve processes, recommend solutions, enhance team performance, and drive progression of client objectives.
  • Prioritize mitigation efforts for action items, risks, and issues.
  • Analyze and address process and software gaps.
Requirements
  • Bachelor's degree or equivalent experience.
  • Able to own and write the Business Requirement Document (BRD) independently for any given domain function with minimal assistance.
  • 5-8+ years of IT and/or business experience in an HMO/PPO Claims, Medicaid, Medicare, and/or managed care healthcare environment.
  • Knowledge of the Affordable Care Act, HMO, and managed care principles including Medicaid and Medicare regulation.
  • Extensive experience with the System Design Life Cycle (SDLC).
  • Experience with EDI X12 structure and syntax rules; chiefly with 834 files.
  • Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis.
Compensation and Benefits

The expected base salary range for this position is $100,000 - $125,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent Health offers comprehensive benefits (including health insurance benefits) to qualifying employees.



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