Business Analyst III (Medicare Risk Adjustment)

DaVita Medical Group - El Segundo, CA3.3

Full-time
EducationSkills
Job Description

OVERVIEW OF POSITION:
Responsible for performing routine and moderately complex activities under limited supervision in order to design, implement, maintain and support policies, processes and systems related to Medicare risk adjustment. Interacts with a wide variety of central support departments, as well as site and regional staff, to accomplish goals.

ESSENTIAL FUNCTIONS:
Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Project management of programs by working with vendors and communities to set up and manage projects to completion.
Monitors programs to ensure data flows through the system as expected.
Maintains weekly program reporting for various audiences, reconciles program invoices, and calculates ROIs.
Processes additional data into the system, ensures that data was processed and researches any interruptions to the process.
Performs quality assurance on data and file submissions to Healthplans during CMS Sweep periods.
Query, analyze, and interpret data for ad hoc analyses.
Responds appropriately to and quickly resolves issues related to department applications or programs; manages customer expectations by keeping them informed of progress.
Develops report specifications and creates complex reports for management or communities using available reporting tools.
Gather information needed for compliance related activities.
Participates in quality assurance process for all new department related system/application/process changes.
Reconciles internal data to Healthplan data.
Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.

EDUCATION:
Bachelor’s degree in Information technology, or closely related field

EXPERIENCE:
Minimum:
Over 5 years and up to and including 7 years of experience.
3 to 5 years background in healthcare industry and managed care.
3 to 5 years experience with MS Access, Excel, and SQL.

Preferred:
3-5 years project management experience.
1 or more years CMS-Risk Adjustment experience.
Experience with Business Intelligence Tools, such as Reporting Services and Analysis Services.
Experience with SharePoint site development and maintenance.

KNOWLEDGE, SKILLS, ABILITIES:
Proficient in Microsoft applications (Access, Excel, Word, SQL).
Strong analytical and problem-solving skills.
Detail oriented.
Experience in data and ad hoc analysis.
Experience with working with large data sets and a variety of sources.
Ability to work efficiently and accurately, while managing multiple priorities, in a fast paced environment.
Proven ability to track and manage all projects, as well as on-going activities within a project.
Good English verbal and writing skills.
Ability to work in a team environment with minimal amount of supervision.
Ability to transfer knowledge and information to teammates from a wide variety of cultural and educational backgrounds.
Ability to cope with fluctuating demands of an uneven workload.
Customer service-oriented.