Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Sentara is hiring for a Senior Business Analyst - Operations

This is a Full-Time position, fully remote, with day shift hours and great benefits!

Work Location:

Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-46854​

Job Description

Designs, produces, and analyzes provider operations data. Creates and maintains reports for business operations and special projects as it pertains to operational processes. Utilizes knowledge of numerous applications, databases, information systems, statistical tools, and analytical principles to monitor and analyze information in support of the business. Assists in the implementation, maintenance, and improvement of information systems.

This position is primarily responsible for assisting the Manager of Analytics in the Provider Operations department with all activities relating to system configuration, regulatory requirements, network adequacy and analysis, process improvement, employee training & development, and project management.

Job Responsibilities

• Ensure the Provider Operations Department adheres to the guidelines set forth by accreditation and regulatory organizations (i.e. NCQA, DMAS, CMS).
• Supports resolution of problems with the state of Virginia, Centers for Medicare and Medicaid, and related regulatory organizations.
• Participates in internal compliance audits for the department.
• Assists with the auditing functions related to the fee schedule and vendor setup through internal reporting tools and monitors all payments and payment methodologies
• Develops and enhances existing corporate metrics for the department.
• Assists the liaison for the provider community when appropriate, including involvement in closing and reassigning member panels, termination/deactivation of contracted providers, researching and resolving provider claim issues
• Assists with the development of internal policies and procedures
• Works closely with the implementation team to validate provider mapping and contract assignment for all lines of business.
• Serves as subject matter expert in regard to provider data setup
• Advocate for data quality and process efficiency
• Develops and executes test cases and has an understanding of system functionality as it relates to provider data and reimbursements based on contractual agreements.
• Trains and develops other analysts in the department on processes, data, and reporting.
• Develops cost analysis for contracting initiatives.
• Serves as the analyst team lead in delegating and mentoring.
• Manages internal, cross-departmental, and third-party vendor team projects.

Minimum Education Requirements

• Four (4) year college degree required.

Special Knowledge and/or Skills

• Strong analytical and technical skills
• 3 years of experience using Microsoft Access, SQL required
• Experience using Crystal Reports, Tableau, QNXT and CredentialStream preferred
• Negotiation skills
• Openly and actively communicates information and takes initiative to communicate extensively
• Handles difficult situations diplomatically
• Ability to build strong relationships within and outside the health plan

Work Background/Experience

• Experience in an analytical capacity required
• Previous experience in health insurance and contracting preferred

Physical Requirements

• Physical health sufficient to meet the ergonomic standards and demands of the position.

Sentara Benefits

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, https://www.sentaracareers.com/explore-sentara/benefits/

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

*Candidates must have a current residence in one of the following states or be willing to relocate Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming

To comply with the State law for salary transparency for the states of Maryland, Nevada, Ohio and Washington, the following hiring range will be applied: $74,933.04 to $112,410.48annually with a target hiring range of $74,933.04 to $89,915.28.

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Talroo–Health Plan

Keywords: Business Analyst, business analysis, QNXT, Tableau, SQL, Microsoft Access, claims, claim, system administration, NCQA, DMAS, CMS, benefit configuration, member enrollment, enrollment, network, provider, network data management, provider data management, provider data, provider contract, provider operations, process improvement, process mapping, flow charting, data analysis, Medicare, Medicaid, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming