Large managed care company is looking for a Sr Business Analyst to assist in monitoring the eligibility loading process, running integrity reports, working with staff to resolve conflicting and rejecting data, obtain revenue files and calculate and prepare client provider payments.
WORK LOCATION : 1901 North Solar Drive, Oxna rd, CA 93036 (3 days / wk), telecommute (2 days / wk)
PAY : $40.00
CONTRACT DATES : CONTRACT TO HIRE
HOURS : M-F, 8-5
RESPONSIBILITIES
- Monitors the daily operations of the department including all workflows, turnaround times, production levels, and staffing needs within budgetary and business planning guidelines.
- Compiles and analyzes monthly enrollment data to provide accurate enrollment schedules to various departments including Financial Analysis, Accounting, Provider Contracting, etc.
- Prepare, analyze and monitor eligibility reconciliations to ensure that all exceptions and rejected data have been researched and updated.
- Assist and ensure that programming changes are requested, justified, and implemented properly for the business unit's eligibility manager software.
- Calculates and prepares client provider capitated payments monthly in line with contract timelines and requirements.
- Effectively and professionally communicate results, challenges and solutions through daily interaction and regular reports with management.
- Create and monitor standard reports to identify anomalies and / or trends impeding appropriate revenue capture. Take action to identify issues and pursue payors to ensure correct payments are being made.
- Responds timely and effectively to requests from other departments as they relate to the functions of the Eligibility department.
- Manages revenue reconciliation by obtaining and monitoring daily revenue activity
QUALIFICATIONS
- Bachelor’s Degree in a related field, Business, Accounting, Finance, health information management, or related field required.
- 2+ years' experience in eligibility and capitation management.
- Ability to demonstrate strong proficiency using MS Suite and other systems.
- Knowledgeable of accounting / revenue functions.
- Strong analytical and problem-solving skills.
- Knowledge of eligibility / insurance verification and managed care administration
MS SQL (preferred)
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