Operational Business Analyst

Financial Planning and AnalysisFinancial Planning and AnalysisFull TimeRemote

Location

United States

Posted

16 days ago

Salary

Not specified

No structured requirement data.

Job Description

Hennepin Health (HH) is seeking an Operational Business Analyst to join their Claim Requirement and Audit team to work within a Health Plan. This team is accountable for researching complex claim related issues, developing claim requirements, executing text plans, and auditing claims. Conduct research and root cause analysis on various claims to identify and resolve problem payment and configuration concerns. Review, research, and respond to the claim related routes received from the delegated claims vendor and other internal HH departments. Solicit and document claim related business requirements for new benefit, DHS, and regulatory changes. Audit and test complex benefit claim payments to prevent incorrect payments and ensure compliance. Develop test cases and complete business user acceptance testing. Facilitate communication between the delegated vendor and internal business departments to follow up and close action items. Collaborate with the delegated vendor to develop interim claim processing workarounds. Monitor claims related to manual workarounds; retire workarounds when solutions are implemented. Support claims related audit functions such as research claims outcomes, validate claims processed according to HH product business rules and DHS regulatory requirements and work closely with account management, internal audit, and across HH to document audit findings.

Job Requirements

  • One of the following: Bachelor's degree or higher in public administration, business administration or related field and four years or more of experience in general administrative work relating to the management of departmental/organizational operations or in a specialty area appropriate to the position. Eight years or more of general administrative work related to the management of departmental/organizational operations or in a specialty area appropriate to the position.
  • Bachelor's degree or higher in public administration, business administration or related field and four years or more of experience in general administrative work relating to the management of departmental/organizational operations or in a specialty area appropriate to the position.
  • Eight years or more of general administrative work related to the management of departmental/organizational operations or in a specialty area appropriate to the position.
  • Five or more years of business analyst or healthcare experience (nice to have).
  • Experience working in claims processing systems and benefit configuration.
  • Experience with health plan and healthcare operations.
  • Experience with Medicaid.
  • Experience documenting business requirements, executing or supporting User Acceptance Testing (UAT), and/or validating configuration changes.
  • Experience working with diverse cultures and applying a health and racial equity and disparity reduction lens to work related duties.
  • Ability to build and maintain relationships with internal and external partners.
  • Ability to prepare plans that meet project and program goals, implement plans, and evaluate results.
  • Ability to analyze and evaluate operational effectiveness and prepare project reports.
  • Ability to manage effective working relationships within and outside the organization.
  • Ability to facilitate group discussions and interpret policies and regulations.
  • Excellent communication and documentation skills.

Benefits

  • This is a full-time, benefit-earning position.
  • Work hours will be Monday through Friday, 8 a.m. to 4:30 p.m. with some flexibility.

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