Overview
The Business Analyst will serve as a critical link between the Utilization Management (UM) operations and IT teams, focusing on optimizing the UM workflows within the clinical platform. This role will analyze business processes, design solutions, and support system implementations and maintenance to enhance operational efficiencies and ensure compliance with regulatory requirements.
Essential Functions/Key Responsibilities:
- Support for Utilization Management team and integrated team workflows across various departments. Route and track complex issues and system configuration requests to IT and other teams as necessary.
- Conduct analysis for issues identified. Intake enhancement requests and recommend potential system solutions.
- Gather business requirements from necessary business stakeholders. Secure leadership approval of the requirements and system workflow/design as necessary.
- Point person for all testing needs for system updates – Operational changes, enhancements, reports, and projects.
- Generate and distribute reports for UM Leadership and Compliance Audits. Perform necessary data analysis to present summaries and recommendations relevant to the audience. Collaborate with the Informatics team for complex reports and dashboards.
- Distribute announcements for system updates and participate in system demonstrations and training content creation as necessary. Coordinate to ensure operationalization of system workflow changes, working with internal and external stakeholders.
- Own adjudication rules monitoring, maintenance, and identify opportunities to improve auto approval rate, in collaboration with Business and IT Teams.
- Own procedure codes and code levels maintenance, in collaboration with Business and IT Teams.
- Participate in analysis and present recommendations for code monitoring and outliers identified by Informatics team(s)
- Own integrated UM workflows in clinical platform, in collaboration with Business and IT Teams
- Own WQ routing and maintenance, in collaboration with Business and IT Teams
- Participate in IT projects representing the department, mitigating potential risks to Utilization Management team KPIs
Competencies:
- Data analysis and interpretation
- Trend and pattern analysis
- System implementations
- Attention to detail
- Ability to elicit, analyze, and communicate business requirements effectively
- Strong analytical, problem-solving, and communication skills
- Work independently, showing initiative and being proactive
- Proficient in Microsoft Office suite
- Ability to thrive in a fast-paced, evolving healthcare environment
Required education and experience:
- Bachelor’s degree in Business Administration, Information Systems, Computer Science, or related field
- 3+ years of business/system analytics experience in a health plan, payer, or managed care organization
- 3+ years of experience working with Epic Tapestry and Epic Reporting Workbench
- Experience analyzing UM and/or CM data
- Experience with UM and CM clinical platforms
- Excellent communication, critical and analytical thinking, and problem-solving skills
- Proficient with MS Office: Excel, Outlook, Word, Teams and PowerPoint
Preferred education, certifications and/or experience:
- Epic Tapestry UM/CM or other related modules certification
- Experience with Agile and Scrum methodologies
- Experience with Jira, Azure DevOps, or similar project management tools
- Master’s degree in Business Administration, Information Systems, Computer Science, or related field
Physical Requirements/Work environment:
- Remote role with occasional travel (Less than 5%)
- Must have a home office, mobile phone, computer with security requirements met.
- Prolonged periods of sitting at a desk and working on a computer.
- Ability to speak, hear, and comprehend both written and verbal communications.
- Internet Speed Minimum of 100 Mbps download and 10–20 Mbps upload
- Typing/data entry of 30 WPM
Other duties:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without advanced notice.
Pay: $55.00 - $60.00 per hour
Education:
Experience:
- business/system analytics experience in a health plan,: 3 years (Required)
- working with Epic Tapestry and Epic Reporting Workbench : 3 years (Required)
- analyzing UM and/or CM data : 3 years (Required)
- Agile and Scrum methodologies : 1 year (Preferred)
- Jira, Azure DevOps, or similar project management tools : 1 year (Preferred)
Work Location: Remote
