Job Description

We have a long term contract for a detail-oriented Business Analyst with 2-4 years of experience in business process or data analysis, ideally within the healthcare or managed care industry. The ideal candidate has a strong background working with claims, billing, or coding data, advanced Excel proficiency, and the ability to analyze trends and translate insights into actionable business improvements. They will support Medicare quality performance measures across multiple states by conducting research, collaborating with internal and provider teams, and identifying opportunities to enhance HEDIS and SDS outcomes. Experience with SQL and knowledge of healthcare quality or pharmacy measures are preferred. 100% Remote.
8-5 CST Monday - Friday
MUST HAVES:

• 2-4 years of business process or data analysis experience, preferably in healthcare
• Have had experience with claims, billing, or claim codes
• Have to be proficient in Excel

NICE TO HAVES:

• Healthcare experience, HEDIS and Pharmacy measure knowledge, SQL

Performance indicators:

• Meeting training requirements - job aids and resources will be provided, etc.

About this Role:

• Responsible for supporting Medicare quality measures for members in Iowa, Kansas, and Missouri.
• This role involves working remotely to conduct research and analysis on performance.
• For someone looking to learn more in regard to quality / HEDIS this would be a good fit
• Collaborative team

Responsibilities:

• Conducting detailed claims research and data analysis to uncover trends and insights.
• Collaborating with the Quality Performance Advisor (QPA) team and provider partners to interpret findings.
• Identifying opportunities to enhance the impact of data on quality performance measures.
• Supporting initiatives to optimize outcomes related to HEDIS and SDS metrics.

:
"Position Purpose:
Perform various analysis and interpretation to link business needs and objectives for assigned function.
Education/Experience:
Bachelor's degree in related field or equivalent experience. 2-4 years of business process or data analysis experience, preferably in healthcare. Project management experience preferred.
Benefits and Payment Configuration
Compliance Coding/Prepay Compliance (Payment Integrity)
Bachelor's degree in related field or equivalent experience. 2+ years of business process analysis, preferably healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience. Knowledge of managed care information systems and experience in benefits, pricing, contracting or claims preferred. Knowledge of provider reimbursement methodologies preferred. Previous structured testing experience preferred.
Encounters:
Bachelor's degree in related field or equivalent experience. 2+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry or 1+ years of managed care encounters experience. Knowledge of claims and/or encounter processing and data analysis experience preferred. Understanding of HIPAA transactions (i.e. 837, 999, 824, 277) preferred. Knowledge of managed care information systems and experience in SQL scripting preferred.
Provider Data:
Bachelor's degree in related field or equivalent experience. 2+ years of business process analysis (documenting business process, gathering requirements) experience in healthcare industry and/or working in a data driven environment. Knowledge of data migration, software enhancement/planning, and Agile preferred.
Member & Provider Solutions
Bachelor's degree in related field or equivalent experience. 2+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry and/or customer service or enrollment functions. Experience managing projects with a high reliance on technology. Knowledge of data integration, software enhancements/planning and Agile preferred." "Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems
Identify and analyze user requirements, procedures, and problems to improve existing processes
Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation
Identify ways to enhance performance management and operational reports related to new business implementation processes
Develop and incorporate organizational best practices into business applications
Lead problem solving and coordination efforts between various business units
Assist with formulating and updating departmental policies and procedures
Performs other duties as assigned
Complies with all policies and standards"

Skills Required