BusinessOperations - Exception Template

110013-Business Analyst II

"Position Purpose:
Perform various analysis and interpretation to link business needs and objectives for assigned function.



Education/Experience:
Bachelor s degree in related field or equivalent experience. 2-4 years of business process or data analysis experience, preferably in healthcare. Project management experience preferred.

Benefits and Payment Configuration
Compliance Coding/Prepay Compliance (Payment Integrity)
Bachelor s degree in related field or equivalent experience. 2+ years of business process analysis, preferably healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience. Knowledge of managed care information systems and experience in benefits, pricing, contracting or claims preferred. Knowledge of provider reimbursement methodologies preferred. Previous structured testing experience preferred.

Encounters:
Bachelor s degree in related field or equivalent experience. 2+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry or 1+ years of managed care encounters experience. Knowledge of claims and/or encounter processing and data analysis experience preferred. Understanding of HIPAA transactions (i.e. 837, 999, 824, 277) preferred. Knowledge of managed care information systems and experience in SQL scripting preferred.

Provider Data:
Bachelor s degree in related field or equivalent experience. 2+ years of business process analysis (documenting business process, gathering requirements) experience in healthcare industry and/or working in a data driven environment. Knowledge of data migration, software enhancement/planning, and Agile preferred.

Member & Provider Solutions
Bachelor s degree in related field or equivalent experience. 2+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry and/or customer service or enrollment functions. Experience managing projects with a high reliance on technology. Knowledge of data integration, software enhancements/planning and Agile preferred."
"Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems

Identify and analyze user requirements, procedures, and problems to improve existing processes

Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation

Identify ways to enhance performance management and operational reports related to new business implementation processes

Develop and incorporate organizational best practices into business applications

Lead problem solving and coordination efforts between various business units

Assist with formulating and updating departmental policies and procedures
Performs other duties as assigned

Complies with all policies and standards"

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Job Profile Summary Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function. Education/Experience: Bachelor s degree in related field or equivalent experience. 0-2 years of business process analysis or data analysis experience. Project management experience preferred. Benefits and Payment Configuration Compliance Coding/Prepay Compliance (Payment Integrity) Bachelor s degree in related field or equivalent experience. 0-2 years of business process analysis (i.e. documenting business process, gathering requirements) or claims payment/analysis experience. Provider Data Bachelor s degree in related field or equivalent experience. 0-2 years of business process analysis (documenting business process, gathering requirements) experience in healthcare industry and/or working in a data driven environment. Knowledge of data migration, software enhancement/planning, and Agile preferred. Member & Provider Solutions Bachelor s degree in related field or equivalent experience. 0-2 years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry and/or customer service or enrollment functions. Knowledge of data integration, software enhancements/planning and Agile preferred. Experience managing projects with a high reliance on technology preferred.
Story Behind the Need
What is the purpose of this team? What is driving this need? (ex. Backfill for FTE or CW, new project, business growth) Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		-Loading healthcare providers to our systems with the appropriate data based on the providers contract and our set-up guides. -Voluntary separation of employee and limited staff on team. -The team is only 2 people at this time, 1 expected to leave. Large projects include new Duals aligned network loads and eventual Behavioral Health and Medical integration into one. -No
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?			-Receive cases in our system from contracting team of new provider contracts or new providers added to an existing contract. Use our set-up guides to identify the correct data to add to the case in our system, based on the contract payment terms. Also, will need to review effective dates, lines of business, and other relevant contractual terms. This is then loaded to our claims payment systems for the providers claims to pay based on the data entered. -Expectations are to complete each case within 1-3 business days. -Small team but large impact on claims payments. Works directly with multiple key departments so able to gain a lot of knowledge quickly.
Candidate Requirements
Education/Certification	Required: Bachelor s Degree or equivalent exp				Preferred:
Licensure	Required: None				Preferred:
Years of experience required: 1+ year medical claims and contracts, Amisys system experience Disqualifiers: No experience with claims or contracts(healthcare). Additional qualities to look for: Attention to detail, Microsoft excel- intermediate , good communication skills.
Top 3 must-have hard skills stack-ranked by importance			1	Contract Interpretation
			2	Medical Claims Payments
			3	Provider Data expertise
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations			Projected Manager Candidate Review Date:			1-2 days post shortlisting
			Type of Interviews:			Teams- Cameras On
			Required Testing or Assessment (by Vendor):			Excel test- intermediate
Next Steps
Do you have any upcoming PTO?			No
Colleagues to cc/delegate			Bruce Wegner
Compliance Questions