What are the responsibilities and job description for the Business Analyst, Encounters and Analytics position at Independent Living Systems?
ABOUT US
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Business Analyst is the encounters subject matter expert and responsible for the accurate, timely and efficient regulatory reporting for all ILS Clients with an emphasis on Florida Community Care. Responsible for assessment of our client’s configuration, claims processing and full operations around their specific Medicare Advantage and state-based programs and ensure that ILS Encounter and Reporting teams are processing files in a compliant and complete manner. Its primary role is to utilize state and federal regulations and materials to ensure ILS programs are meeting the current and up-to-date processes and requirements to meet each of our client’s requirements related to services ILS performs on behalf of the client.
Essential Functions
- The Business Analyst is responsible for the accurate, timely and efficient regulatory reporting for all ILS Clients with an emphasis on Florida Community Care.
- Responsible for completing functions to meet monthly submissions and tracking of encounter data files for each of ILS clients and respective vendors.
- The incumbent will be responsible for ensuring effective work-flow changes, validating testing and documentation relative to the various encounter reporting requirements (state and federal).
- Works with IT and business leadership (corporate and market based) to effectively provide access to information and data to maintain business lead by the organization supporting clients inclusive of state and federal regulatory reporting.
- Together with internal functional partners, ensure we meet or exceed Medicaid and Medicare Encounter/RAPS requirements and internal goals for clients by: Ensuring Encounter submissions meet state requirements.
- Perform necessary data pulls and analytics to pre-determine failures in encounter data extracted from claims system.
- Research and oversee document changes to encounter and RAPS/EDPS processes and ensure updated processing documentation is correct.
- Works with delegated and subcontracted entities to insure timely, accurate and complete transmission of encounters are submitted to state or federal agencies. Reviewing, researching, investigating and correcting encounter issues through data and process analysis.
- Maintain Encounter reporting describing results against internal goals; presenting results and issue updates. Develop and maintain all Encounter reporting technical documentation.
Education and Experience
- Bachelor’s degree in Business Administration, Computer Science or IT, related field or equivalent experience; Master’s degree in public health or health care administration preferred.
- 2 or more years programming and demonstrated management of programing and analytical staff.
- Statistical analysis or data analysis experience, preferably in a healthcare setting.
- Medicare and Medicaid managed care experience a plus.
Required Skills
- EDI 837 Encounter Experience preferred.
- Business or data analysis experience, preferably in a healthcare setting
- Medicare and Medicaid managed care experience a plus.
- Knowledge of various data mining, reporting, and reconciliation tools and methodologies.
- Advanced knowledge in MS Office tools
- SQL knowledge preferred
EEO STATEMENT
In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
