Business Data Analyst, Medicare Advantage

In this role, you will serve as a liaison between business stakeholders and Application/IT teams, translating business needs into requirements and supporting system solutions for encounter data operations.

You will:

• Gather and document business and functional requirements, process flows, business cases, system specifications, test cases, and other SDLC materials.

• Analyze data, business processes, electronic transactions, and file exchanges to identify system gaps and opportunities to improve processes.

• Coordinate testing with trading partners and certification authorities.

• Support the design, development, testing, and implementation of software and Tapestry ISS enhancements.

• Develop and maintain interface documentation, policies, and procedures.

• Investigate operational issues and variances, prepare stakeholder reports, and present findings and recommendations to leadership.

• Support internal and external audits, quality control, regulatory requirements, and operational standards.

Salary Range: $82,434 - $171,779/annually

Note: This posted position is 1 of 2 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions.

We’re seeking a self-motivated and results-driven individual with:

• Bachelor’s degree in business, information systems, healthcare, or a related field required

• 5 or more years of experience managing enrollment, claims, or encounters in a Medicare or managed care environment required

• 5 or more years of experience with CMS processes required

• Computer proficiency with Microsoft Office, SQL, and data visualization tools

• Knowledge of encounter regulatory reporting and compliance requirements

• Experience managing vendors to contractual requirements

• Ability to research and resolve encounter issues

• Understanding of the healthcare model, capitation, and other managed care IPA and provider reimbursement methodologies

• Knowledge of physician/facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue and HCPCS coding

• Strong leadership, interpersonal, analytical, problem-solving, and prioritizing skills

• Excellent oral and written communication skills

• Ability to develop, implement, and evaluate methods and systems to improve efficiency

• Ability to work well independently as well as part of a team

As a condition of employment , the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.
Current/former UC employees are subject to a personnel file review.