Senior Business Analyst - Operations

Company: Sentara Health
Location: Richmond
Posted on: April 17, 2024

Job Description:

City/State
Richmond, VA

Overview

Work Shift
First (Days) (United States of America)

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Sentara is hiring for a Senior Business Analyst - Operations

This is aFull-Timeposition, fully remote, with day shift hours and great benefits!

Work Location:

Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-46854

Job Description

Designs, produces, and analyzes provider operations data. Creates and maintains reports for business operations and special projects as it pertains to operational processes. Utilizes knowledge of numerous applications, databases, information systems, statistical tools, and analytical principles to monitor and analyze information in support of the business. Assists in the implementation, maintenance, and improvement of information systems.

This position is primarily responsible for assisting the Manager of Analytics in the Provider Operations department with all activities relating to system configuration, regulatory requirements, network adequacy and analysis, process improvement, employee training & development, and project management.

Job Responsibilities

• Ensure the Provider Operations Department adheres to the guidelines set forth by accreditation and regulatory organizations (i.e. NCQA, DMAS, CMS).
• Supports resolution of problems with the state of Virginia, Centers for Medicare and Medicaid, and related regulatory organizations.
• Participates in internal compliance audits for the department.
• Assists with the auditing functions related to the fee schedule and vendor setup through internal reporting tools and monitors all payments and payment methodologies
• Develops and enhances existing corporate metrics for the department.
• Assists the liaison for the provider community when appropriate, including involvement in closing and reassigning member panels, termination/deactivation of contracted providers, researching and resolving provider claim issues
• Assists with the development of internal policies and procedures
• Works closely with the implementation team to validate provider mapping and contract assignment for all lines of business.
• Serves as subject matter expert in regard to provider data setup
• Advocate for data quality and process efficiency
• Develops and executes test cases and has an understanding of system functionality as it relates to provider data and reimbursements based on contractual agreements.
• Trains and develops other analysts in the department on processes, data, and reporting.
• Develops cost analysis for contracting initiatives.
• Serves as the analyst team lead in delegating and mentoring.
• Manages internal, cross-departmental, and third-party vendor team projects.
  
  Minimum Education Requirements
  
  
  • Four (4) year college degree required.
    
    Special Knowledge and/or Skills
    
    
    • Strong analytical and technical skills
    • 3 years of experience using Microsoft Access, SQL required
    • Experience using Crystal Reports, Tableau, QNXT and CredentialStream preferred
    • Negotiation skills
    • Openly and actively communicates information and takes initiative to communicate extensively
    • Handles difficult situations diplomatically
    • Ability to build strong relationships within and outside the health plan
      
      Work Background/Experience
      
      
      • Experience in an analytical capacity required
      • Previous experience in health insurance and contracting preferred
        
        Physical Requirements
        
        
        • Physical health sufficient to meet the ergonomic standards and demands of the position.
          
          Sentara Benefits
          
          Sentara employees strive to make our communities healthier places to live. We re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits,
          
          Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!
          
          * Candidates must have a current residence in one of the following states or be willing to relocate Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming
          
          To comply with the State law for salary transparency for the states of Maryland, Nevada, Ohio and Washington, the following hiring range will be applied: $74,933.04 to $112,410.48 annually with a target hiring range of $74,933.04 to $89,915.28.
          
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          Keywords: Business Analyst, business analysis, QNXT, Tableau, SQL, Microsoft Access, claims, claim, system administration, NCQA, DMAS, CMS, benefit configuration, member enrollment, enrollment, network, provider, network data management, provider data management, provider data, provider contract, provider operations, process improvement, process mapping, flow charting, data analysis, Medicare, Medicaid, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming
          
          Job Summary
          
          Designs, produces, and analyzes provider operations data. Creates and maintains reports for business operations and special projects as it pertains to operational processes. Utilizes knowledge of numerous applications, databases, information systems, statistical tools, and analytical principles to monitor and analyze information in support of the business. Assists in the implementation, maintenance, and improvement of information systems.
          
          This position is primarily responsible for assisting the Manager of Analytics in the Provider Operations department with all activities relating to system configuration, regulatory requirements, network adequacy and analysis, process improvement, employee training & development, and project management.
          
          Qualifications:
          
          BLD - Bachelor's Level Degree (Required)
          
          Related
          
          Skills
          
          Communication, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Microsoft Excel, Operations Analysis, Systems Analysis
          
          Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
          
          Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.
          
          In support of our mission to improve health every day, this is a tobacco-free environment. Associated topics: analyse, examiner, financial analyst, financial analytic, government, inspect, investment banking, market, refinement, strategy

Keywords: Sentara Health, Richmond , Senior Business Analyst - Operations, Professions , Richmond, Virginia