Business Analyst, Claims

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities.

What You Will Do

• Maintains analysts' library of resources. Develops library of pertinent books and articles on information systems for the department.
• Develops an understanding of VNS Health Plans strategic business objectives and business unit operations, along a particular health plan value stream. Articulates business issues and designs data collection methodologies.
• Provides data collection and analytical support to team and monitors projects. Summarizes, creates, and distributes reports as needed.
• Participates in interdepartmental work groups in support of process improvement projects, as needed.
• Assists in the design and delivery of presentations on project status and outcomes to management.
• Monitors new and existing process designs to measure operational effectiveness.
• Provides financial impact analysis for all retro compensation grids as a result of amendments or new published state rates.
• Acts as a liaison between the claims department, providers and other internal departments.
• Manages workload and inventory according to departmental SLA.
• Identifies and creates global claim projects.
• Reviews claims disputes and pends within departmental SLA.
• Identifies and reports dispute trends.
• Participates in special projects and performs other duties as assigned.

Education:

• Bachelor's Degree in Business or related discipline or the equivalent work experience, required
• Master's Degree in Business Administration, Public Administration or related field, preferred

Work Experience:

• Two years' experience with claims in a healthcare setting required
• A year of experience with a managed care organization on business transformationrequired
• Two years' experience using FACETS, SQL scripts & queries, OBIEE, Power BI, Tableau & MicroStrategy reports & dashboards; project management & SDLC methodologies, with contracting and new business management across relational databases, using Oracle, SQL Server & DB2, managing stakeholder expectations and providing HIPAA-compliant guidance to business partners, vendors, and end-users, per industry standards for EDI protocols preferred
• Strong command of Microsoft Office Tools (Word, Excel, Visio, and PowerPoint) required
• Effective oral and written communication skills, consulting and analytical skills and ability to work with clients, IT management, staff, consultants and vendors required
• Ability to function autonomously, and collaborate with most senior level leaders across the agency required
• Demonstrated understanding of NYS, CMS and Medicaid reimbursement guidelines. APG, APC, DRG required