APN Consulting Inc
Edison, NJ
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Job Description :
Job Title: Business Professional - Business Analyst II
Location: Remote (Must be willing to work EST hours)
Duration: 6 Months
Job Description:
True Job Title - Sr. Analyst, Health Plan
Work hours - M-F 8-5 pm EST
Fully remote
Summary:
The purpose of the Sr. Provider Data Analyst is to analyze complex business problems and issues using data from internal and external sources to provide insight to decision-makers. Identifies and interprets trends and patterns in datasets to locate influences. Constructs forecasts, recommendations, and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. Collaborates with health plans and shared services to modify or tailor existing analyses or reports to meet their specific needs. May participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. This is a general role in which employees work with multiple types of business data. Work is internal operations focused.
Responsible for accurate and timely identification of critical information on configuration and claims databases. Maintains critical knowledge of configuration and claims databases. Oversees operational and claims systems and application of business rules as they apply to health plans. Validates data to be housed in databases and ensures adherence to business and system requirements of the health plan as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
Essential Functions:
  • Analyze and interpret data to determine appropriate configuration changes.
  • Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converts these terms to configuration parameters.
  • Oversees coding, updating, and maintaining benefit plans, provider contracts, fee schedules, and various system tables through the user interface.
  • Applies previous experience and knowledge to research and resolve claim/encounter issues, and pending claims and update system(s) as necessary.
  • Works with fluctuating volumes of work and can prioritize work to meet deadlines and needs of the user community.
  • Provides analytical, problem-solving foundation including definition and documentation, specifications.
  • Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements.
  • Reviews, researches, analyzes and evaluates all data relating to specific areas of expertise. Begins the process of becoming a subject matter expert.
  • Conducts analysis and uses analytical skills to identify root causes and assist with problem management as it relates to state requirements.
  • Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery, and cost savings regulations are met.
  • Prepares high-level user documentation and training materials as needed.
  • Works to identify opportunities for continuous improvement, standardization, and reduction of rework across health plans and shared services.
  • Monitors, coordinates and communicates the strategic objectives of health plans across shared services to optimize performance/results.
  • Aggregates and assists with the analysis of health plans and shared service data.

Experience:
  • 2-5 years

Education/ Training:
  • Bachelor's Degree or equivalent combination of education and experience
  • 1-3 years of formal training in Business Analysis and/or Systems Analysis



Client : APN Consulting
             

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