Business Operations Analyst

Profile

Business Operations Analyst','Full-time','Provider Network','Days','Days','80','80','None','None','WASHINGTON-FEDERAL WAY-FEDERAL WAY-HERON BLDG','','!*!Summary This position supports health plan operations on a national, regional and market level. May provide support to other health plan functions based on business need.  Areas of focus may include Enrollment, Billing, Reconciliation, Claims, Benefit Configuration, Contract Configuration, Appeals & Grievances, Audit & Recovery, Relationship Management, etc.  Responsible for improving & implementing process changes related to all of the health plan functional areas listed above.  This includes creation of current process roadmaps and evaluation of capabilities and technology used to support those functions.  Must be able to work in cross-functional environment and balance multiple projectsEssential Duties and Responsibilities: This role will assist in analyzing business processes against state and federal regulations and organizational and industry best practices to ensure compliant and efficient operations.  This may include: • Supports development of the national standards for health plan operations to ensure consistency with standardized contract language, guidelines, key definitions, tools and processes.• Reviews, creates or updates standard processes and tools to support the operational component of the contracting lifecycle and to achieve best-in class capabilities. Continually looks for ways to improve the operational processes and tools for end users and leads the design/implementation of such improvements.• Develops, reviews, revises and finalizes templates, user guides, policies and procedures related to the development of various national standards for health plan operations.• Develops, implements and maintains standard processes and tools to support the integrity and accuracy of health plan operations.  Provides education and training as required.• Produces, reviews, implements and distributes real-time reports utilizing tools developed for defined time periods and regions that support national visibility across all contracts to National leadership.','!*!Education and Experience Bachelor’s Degree preferred or 3 years of health plans operations experience.  3 or more years of health plan experience; knowledge of managed care contracting and Medicare reimbursement methodology preferred.  Ideal candidate will demonstrate progressively responsible healthcare work experience in payer and/or provider health plan operations.• Knowledge of health plan principles, key terms/definitions, and contract negotiations.• Proven ability to interpret health plan terms and regulations and translate applicability to other areas of the business.• Business experience in problem-solving for complex and multi-disciplinary capabilities at a market, regional and/or national level.• Experience in developing processes and tools for business models and operations across an organization and implementing them successfully.• Demonstrated business experience in supporting, managing, and leading projects and initiatives. • Proven ability to translate concepts/ideas into written material (e.g. presentations, whitepapers, newsletters, policies, process flows, etc.) and verbally.• Proficiency in Microsoft Office suite including Word, Excel, Outlook, PowerPoint, Access, SharePoint, and Visio.• Comfortable with ambiguity in a fast-paced environment.  Ability to work effectively under deadlines and produce accurate work. • Exceptional communication skills including written and interpersonal.• Extremely self-motivated with effective time management skills.• Highly demonstrated ability to work effectively in a matrix-oriented organization.• Proven ability to work independently as well as collaboratively to achieve specific goals and objectives and provide recommendations for improvement.','We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.','2017-R0136419','QualChoice Health','Business Operations Analyst

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