Business Analyst

Description The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and external partners. This role is responsible for gathering and documenting business and system requirements, analyzing and interpreting data to support cross-functional operations, and driving system enhancements to improve efficiency and compliance. The analyst will also support testing, report generation, and documentation efforts related to software and process improvements. Key Responsibilities: • Gather and define business and technical requirements to support electronic data exchanges and system enhancements • Collaborate across teams to design and implement effective business solutions • Develop documentation including business cases, test cases, and process flows • Perform data analysis and reporting to support operational decisions • Lead and support audits, quality control initiatives, and performance improvement efforts • Coordinate with IT and trading partners to implement Tapestry ISS and other system enhancements • Ensure compliance with organizational policies and regulatory standards Salary Range: $76,200 - $158,800/Annually Qualifications • Bachelor’s Degree in Business Administration, Information Systems, Health Care or other related field required • Minimum of five years’ experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required • Minimum of five years’ experience with CMS processes in a Medicare or Managed Care environment required • Experience with CMS processes is a plus • Knowledge of SQL window-based computer environment including MS Office and related programs is a plus • Knowledge of encounter regulatory reporting and compliance requirements. • Experience managing vendors to contractual requirements. • Strong ability to research and resolve encounter issues. • Strong knowledge of the health care model, capitation and other managed care IPA and provider reimbursement methodologies. • Strong knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding. • Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, and meet deadlines. • Demonstrated ability to analyze and organize complex federal and private insurance regulations. • Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools. • Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines. • Reliability and compliance with scheduling standards. • Strong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essential. • Ability to develop, implement, and evaluate methods and systems to improve efficiency. • Proven skills to lead and facilitate cross-functional workgroups and other meetings. • Ability to analyze and organize complex federal and private insurance regulations. • Must be effective at working independently with minimal supervision. • Ability to support the working hours of the department. • Ability to travel/attend off-site meetings and conferences. • Must be customer service oriented, be able to work well individually and as part of a team; and have a strong work ethic.