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Sr. Business Analyst - Nevada | AMERIGROUP - Nevada | Las Vegas, NV
JOB SUMMARY:
Provides senior level business analysis and project management.
Accountable for data reporting and analysis, managing assigned projects,
utilizing and evaluating claim data to help develop, track, monitor, and
report savings initiatives in revenue, cost, and utilization.
PRIMARY RESPONSIBILITIES:
1. Provide data analysis support for Health Plan.
2. Utilize knowledge of databases, information systems, statistical
tools and analytical principles to analyze outcomes that support
strategies for managing health plan performance.
3. Generate monthly management metrics, clinical dashboards and state
reporting requirements
4. Identify and research root causes and drivers for savings
initiatives (i.e. Medical Earnings Initiatives, overpayments, claim
discrepancies)
5. Develop applications and reports using Excel, SQL based tools, and
MS Access.
6. Develop ad-hoc reports to identify early detection of
systemic/business environment issues causing payment discrepancies
(changes in authorization requirements, upgrades, system conversions,
CMS guidelines, etc.).
7. Develop and utilize knowledge of databases, information systems,
managed care, Medicaid/CHIP population, statistical tools and analytical
principles to analyze quality outcomes that support strategies for
managing health plan performance.
8. Manages contracting projects for Provider Relations.
9. Identify and implement operational improvements to include
automation where possible.
10. Act independently, under general direction, to gather requirements,
collect data and perform financial and claims analysis; provide
interpretation of analysis, reports, methodologies, source data and
systems.
11. Develop, communicate, and monitor project schedules and resource
plans.
12. Other duties as assigned.
EDUCATION AND EXPERIENCE:
Education:
Required:
- Bachelor's Degree in IT, Business, Finance or equivalent
Years and Type of Experience:
Required:
- Minimum 2+ years experience with increasingly complex database and
data management responsibilities.
- Experience with multiple data systems and models preferred.
- Strong background in compiling data, creating reports and
displaying information;
- Experience combining clinical and financial data.
- Heavy experience with SQL query, MS Access and MS Excel.
- Minimum 2+ years experience in claims research/investigation.
Specific Technical Skills:
Required:
- High proficiency with PC based systems, specifically MS Excel, MS
Access, SQL programming, data mining, ad-hoc reporting, query
development, relational databases, and data warehouses.
- Ability to extract and synthesize data; conduct and interpret
quantitative and qualitative results
- Knowledge of payment and reimbursement methodologies (Medicaid,
Medicare)
- Flexibility in managing multiple projects of moderate to complex
scope based on strategic priorities with general supervision from
Finance and Provider Relations
- Excellent oral and written communication skills and ability to
successfully communicate with technical and non-technical personnel.
- Demonstrated ability to meet established deadlines.
- Problem solving, analytical ability and interpersonal skills are
important to perform successfully in this position.
- Good organizational skills; the ability to handle multiple
priorities simultaneously with a high quality result
- Ability to develop creative solutions to problems and to seek
alternatives, new ideas, and or approaches to problems.
- Demonstrates motivation and innovation for self improvement
- Demonstrate ownership skills when handling internal or external
customer concerns or issues.
- Able to identify, analyze, and solve problems and to work with
teams to solve problems.
Preferred:
- Knowledge of ICD-9 and CPT coding system and claims processing
Other:
Required:
- Appreciation of cultural diversity and sensitivity towards target
population.
PHYSICAL REQUIREMENTS
- Must be able to operate a computer
- Must be able to operate a telephone
In accordance with state and federal laws, employment offers are
tendered solely on the basis of qualifications without regard to race,
religion, color, national origin, age, sex, marital status, sexual
orientation, handicap (including disabled veterans) or Vietnam Era
veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of
employment and a satisfactory criminal history background report.
To apply for this position, please copy and paste the following link
into your browser address bar:
http://amerigroup.contacthr.com/15963204
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