Utilization and Appeals Management Analyst

Position Summary:

Performs extensive data analytics, documents findings and recommendations to meet department and corporate goals. Builds, documents and maintains workflows related to all phases of department processes and systems. Able to act as an operations' liaison, collaborating with various entities including payers, clinical, financial and/or operational departments.

Duties/Responsibilities:

• Conducts data analysis with a high degree of complexity and prepares written reports of findings.
• Makes recommendations about the best approach to resolving a business problem.
• Ability to break down complex problems into manageable tasks.
• Able to work with payers and manage problem cases and resolution.
• Creates and maintains appropriate departmental records, spreadsheets and workflow documentation.
• Assists department in meeting regulatory requirements.
• Ability to communicate and manage project scope; Assist in work plan development and management; contributes to completion of project status reports.
• Lead meetings with staff and/or leadership to assist in establishing project priorities and documents outcomes.
• Supports the operational and financial performance through the development of analytics (financial, operational and clinical) and corrective action plans which improve process flows and efficiency 
• Ensures the accuracy and comprehensiveness of the reports and data sources, and provides support and training on reporting topics. 
• Executes project planning (including planning, organizing, and managing resources) and all phases of the project management life cycle for a variety of initiatives 
• Actively responds to questions and queries, work to reinforce best practices and methods, and provides follow-up support. 
• Updates and maintains all databases to maintain data integrity.
• Prepares monthly and quarterly reports reflecting accurate departmental data
• Works with Revenue Cycle and Managed Care teams to identify and resolve issues related to timely resolution of managed care cases
• Ability to work on multiple projects in a fast-paced environment

Position Requirements and Qualifications:

• Master’s Degree in Health Care Management, Business Administration or Finance/Economics or 10 years equivalent experience with related skills
• Four or more years of project management experience with demonstrated success in planning, execution, and closing complex projects. 
• Advanced MS Excel and Access application experience. Highly Desired Requirements: working knowledge of relational database architecture, table and data sets (i.e., Access\MS-SQL); EPIC, and other reporting and database tools. 
• Sound knowledge of Medicaid, Medicare and managed care requirements
• Must be Self-directed
• Competent in preparation and analysis of reports
• Demonstrated experience in complex organizations serving diverse constituencies with focus on analytics, project management, health care management, business administration and related fields
• Attention to detail, patience, and a positive, customer-centric attitude which includes empathy, tact, and emotional maturity. 
• Good communication and interpersonal skills that support productive work with all levels of staff, and effective communications with diverse populations.