Business Analyst, Claims

Overview

Works directly with management on highly visible projects to understand business needs and challenges of managed care payors and to develop innovative solutions to meet those needs. Gathers requirements, performs analysis, designs new or enhanced systems to meet operational, business, and clinical needs. Collaborates with Business Unit and/or Project Manager on assigned projects. Works under general supervision.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Maintains analysts' library of resources. Develops library of pertinent books and articles on information systems for the department.
• Develops an understanding of VNS Health Plans strategic business objectives and business unit operations, along a particular health plan value stream. Articulates business issues and designs data collection methodologies.
• Provides data collection and analytical support to team and monitors projects. Summarizes, creates, and distributes reports as needed.
• Participates in interdepartmental work groups in support of process improvement projects, as needed.
• Assists in the design and delivery of presentations on project status and outcomes to management.
• Monitors new and existing process designs to measure operational effectiveness.
• Provides financial impact analysis for all retro compensation grids as a result of amendments or new published state rates.
• Acts as a liaison between the claims department, providers and other internal departments.
• Manages workload and inventory according to departmental SLA.
• Identifies and creates global claim projects.
• Reviews claims disputes and pends within departmental SLA.
• Identifies and reports dispute trends.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:

• Bachelor's Degree in Business or related discipline or the equivalent work experience required
• Master's Degree in Business Administration, Public Administration or related field preferred

Work Experience:

• At least one year of experience must be with a managed care organization on business transformation. required
• Two years experience using FACETS, SQL scripts & queries, OBIEE, Power BI, Tableau & MicroStrategy reports & dashboards; project management & SDLC methodologies, with contracting and new business management across relational databases, using Oracle, SQL Server & DB2, managing stakeholder expectations and providing HIPAA-compliant guidance to business partners, vendors, and end-users, per industry standards for EDI protocols. preferred
• Strong command of Microsoft Office Tools (Word, Excel, Visio, and PowerPoint) required, and mobile computing platforms & web- based technologies. required
• Effective oral and written communication skills, consulting and analytical skills and ability to work with clients, IT management, staff, consultants and vendors required
• Ability to function autonomously, and collaborate with most senior level leaders across the agency required
• Demonstrated understanding of NYS, CMS and Medicaid reimbursement guidelines. APG, APC, DRG required

Pay Range

USD $63, USD $79,800.00 /Yr.

About Us

VNS Health is one of the nation's largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 "neighbors" who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.