Medicaid Senior Business Process Analyst

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Company :

United Concordia Dental

Job Description :

JOB SUMMARY

This job provides expertise for moderately to very complex problem solving and complete understanding of system functionality. The incumbent reviews significant amounts of information and analyzes processes to support business unit needs, specifically those related to Medicaid operations, compliance and reporting. Troubleshoots errors, conducts impact analyses, and/or solves data rejection. Performs business analyses in one or more operational areas related to Medicaid. Identifies process gaps and recommends process improvements for efficiencies. Provides guidance and education to Associate and Intermediate level employees. This role requires significant collaboration with internal and external stakeholders, including Managed Care Organizations (MCOs) and regulatory bodies.

ESSENTIAL RESPONSIBILITIES

• Intake operational objectives and gather information. Define, understand, and manage project scope. Perform moderate/complex research to support evaluation of complex output requirements and formats. May translate more complex business initiates to less experienced employees. Present project deliverables to appropriate audiences. Create reports on financial/operational performance. Communicate business operational requirements to internal groups responsible for developing/testing business requirements in various applications.
• Coordinate, monitor, and report on the progress of projects to ensure adherence to defined project schedule. Communicate effectively with customers and colleagues. Successfully articulate issues, problem, and solutions. Conduct and oversee pre and post-implementation review. Successfully plan, design, and conduct functional walk-throughs. This includes developing workplan documentation in response to regulatory requests.
• Manage and advise on intermediate to large cross-functional projects and change initiatives involved in the design and delivery of business process solutions, implementation strategies, and control measures, including scoping, leading, and influencing organizational change related to business processes and models. This includes providing consultative support in the implementation process of new Medicaid-related MCOs.
• Facilitate process improvement meetings and/or discussions.
• Identify reporting needs through collaboration with MCOs/partners, Analytics & Reporting teams to define requirements and ensure reporting needs meet regulatory and contract standards.
• Provide audit/operational oversight and analytical expertise in reviewing Medicaid administrative operations and determining remediation requirements. This includes developing documentation and preparing materials for responding to external audit requests.
• Provide support in the appeals & grievances and complaints tracking & resolution processes impacting Medicaid-related businesses.
• Support day-to-day Medicaid administrative support needs, including encounters reporting, policy and procedure documentation, and escalated issues resolution.
• Analyze the functions and operations of a business area/function and identify problem areas. Create process mapping and documents current and future state business processes.
• Act as subject matter expert/technical operations expert. Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies.
• Provide a broad range of budget, financial, and/or operational analysis for a large department or division. May develop budgetary/fiscal goal.
• Develop desktop procedures and training materials. May train employees on new processes.
• May perform special projects upon request and oversee the work of less experienced employee.
• Other duties as assigned.
  
  

EDUCATION

Required

• High School Diploma/GED
  
  

Preferred

• Bachelor's Degree
  
  

EXPERIENCE

Required

• 5 - 7 years of experience in a Business Analyst or Business Process Analyst role or experience in a related operational area (e.g. claims, billing, customer service, etc.)
  
  

Preferred

• Experience with Medicaid/CHIP programs is highly desirable
• 3 - 5 years in the Health Insurance Industry, with focus on Medicaid
  
  

LICENSES AND CERTIFICATIONS

Required

• None
  
  

Preferred

• None
  
  

SKILLS

• Analysis of business problems/needs
• Written & Oral Presentation Skills
• Business Analysis
• Business Process Design
• Business Process Improvement
• Business Process Mapping
• Business Requirements
• Collaborative Problem Solving
• Project Management
• Medicaid Program Knowledge (Highly Preferred)
• Regulatory Compliance Knowledge (Highly Preferred)
• Data Analysis and Reporting Skills (Highly Preferred)
  
  

Language (Other Than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Never

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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Req ID: J260120