Job Summary
Summary: Develop new business process flow requirements and functional specifications for projects. Plan and create deliverables which effectively detail and communicate analysis results. Transition knowledge to/from operational business resources. Work with Payroll and management to ensure business needs are addressed with appropriate priority. Track and report status and issues to appropriate parties. Accountable for delivering work products that comply with regulatory and/or contractual requirements.
• Work directly with managers and partners to understand their business needs, strategies, priorities and key issues. • Assimilate and document this information into business requirements. • Develop process flow for functions; develop resources to assist operational functions between clients and departments. • Liaison to departments ensuring strategic solutions meets business requirements. • Trainer for departments with new products and services implementations. • Perform orientation presentations for new hire on boarding process. • Work closely with managers and Special Projects. Knowledge/Skills/Abilities: • Excellent verbal and written communication skills • Ability to abide by policies • Maintain regular attendance based on agreed-upon schedule • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Must have skills:
· 5+ years related experience in Healthcare Payor domain with a focus on Provider Network Management/Provider Contracting · Demonstrated competency related to Provider contract implementation preferably with CA Medicaid · Proficiency in analyzing and understanding contract terms, payment structures, reimbursement methodologies, network adequacy.
Day to Day Responsibilities:
· Able to review, understand different types of Provider Contracts · Analyzes 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 clients to modify or tailor existing analysis or reports to meet their specific needs ·
Required Education: Bachelor’s degree. Emphasis in business operations/management preferred. Will accept experience in lieu of formal education.
Required Experience: Minimum of 5-7 years proven analytical experience.