Senior Business Analyst

4 weeks ago

Oxnard, United States Insight Global Healthcare Full time
Job DescriptionJob Description

Required Qualifications:
• Bachelor’s Degree in a related field, Business, Accounting, Finance, health information management, or related field required.
• 2+ years' experience in eligibility and capitation management.
• Ability to demonstrate strong proficiency using MS Suite and other systems.
• Knowledgeable of accounting/revenue functions.
• Strong analytical and problem-solving skills.
• Ability to follow verbal and written instructions
 
Preferred Qualifications:
Knowledge of eligibility/insurance verification and managed care administration
MS SQL

Primary Responsibilities:
• Monitors the daily operations of the department including all workflows, turnaround times, production levels, and staffing needs within budgetary and business planning guidelines.
• Compiles and analyzes monthly enrollment data to provide accurate enrollment schedules to various departments including Financial Analysis, Accounting, Provider Contracting, etc.
• Prepare, analyze and monitor eligibility reconciliations to ensure that all exceptions and rejected data have been researched and updated.
• Assist and ensure that programming changes are requested, justified, and implemented properly for the business unit's eligibility manager software.
• Calculates and prepares client provider capitated payments monthly in line with contract timelines and requirements.
• Effectively and professionally communicate results, challenges and solutions through daily interaction and regular reports with management.
• Create and monitor standard reports to identify anomalies and/or trends impeding appropriate revenue capture. Take action to identify issues and pursue payors to ensure correct payments are being made.
• Responds timely and effectively to requests from other departments as they relate to the functions of the Eligibility department.
• Manages revenue reconciliation by obtaining and monitoring daily revenue activity.
• Coordinate with other staff.
• Creates, analyzes, ad hoc reports to ensure all revenue is accounted for, and paid according to contract. Partners with finance to understand variances, and fluctuations in revenue received.

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