Business Analyst – Enterprise Operations Reporting & Controls

AmeriHealth Caritas is a mission-driven organization dedicated to improving healthcare solutions. The Business Analyst, EO Reporting & Controls will support the creation and maintenance of reporting systems, ensuring data integrity and facilitating data-driven decisions within the organization.

Responsibilities:

• Support the development and maintenance of standard key performance indicator reports that allow for data driven decisions
• Identify, research and analyze data outliers and/or irregularities in departmental and interdepartmental reports
• Interpret business requirements to identify technical specifications to produce prescribed report outputs
• Assists in the design and/or standardization of the process by which member and provider appeals data is collected, trended, stored and disseminated
• Utilize real time reports to proactively identify potential issues to mitigate Health Plan risk
• Participate in collaborating with internal and external business areas to maintain a current working knowledge of contractual, regulatory, internal and informational metrics, requirements and service levels
• Complete frequent reviews of current reporting processes to ensure accuracy of data and identify opportunities for efficiencies
• Participate in projects and assess impacts to reporting; including new report development, data/rule changes, parameter/assumption modifications and process amendments
• Consult with stakeholders to determine appropriate course of action prior to enacting changes in reporting processes
• Produce accurate, timely results within departmental timeframes to meet standard and ad hoc reporting needs

Requirements:

• Bachelor's Degree or equivalent work experience
• 1 or more years health care experience with specific experience in claims analysis and operations
• Ability to analyze large data sets and make defensible recommendations
• Ability to engage and communicate with individuals at all levels
• Demonstrated ability function autonomously and as part of a team
• Excellent organizational, analytic and interpersonal skills required
• General knowledge of appeals process and information flow in a managed care environment
• Expanded analytic and technical skills
• Clear working knowledge of MS Office Suite (including Microsoft SQL) required
• Prior experience working with and analyzing large data sets
• 3+ years health care experience with specific experience in claims analysis and operations
• Previous experience with the Jiva system preferred
• Previous experience with Tableau preferred
• NCQA and DHS State reporting knowledge preferred
• Knowledge or ability to learn Business Intelligence tools
• Previous Healthcare or Managed Care experience