Financial Operations Analyst Lead - Payment Integrity Datamining
Role details
Job location
Tech stack
Job description
Among us are care providers, engineers, data scientists, and other dedicated professionals determined to recover, eliminate and prevent unnecessary medical-expense spending.
The Financial Operations Analyst Lead is responsible for analyzing data and providing new processes, system enhancements and technical solutions to complex business issues. Leads and coaches staff. Manages workflow and oversees day-to-day department responsibilities. May conduct operational meetings with staff. Assists management in establishing work goals. Prepares management reports and may do budget variance.
How you will make an impact:
- Develops and executes complex data analysis.
- Develops strategic report applications from Finance systems.
- Writes queries and macros to enhance access databases and builds new databases in support of accurate balance sheet/P&L reporting.
- Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms.
- Interfaces with IT as needed and documents and tracks any needed system enhancements with IT management.
- Documents and responds to any external audit requests.
- Assists in the implementation of software releases within the Finance organization.
- Ensures proper conversion or shutdown of legacy systems by developing and documenting enterprise solutions for successful transition to core processing systems.
- Has technical and operational expertise.
- Can commit department to deliverables on own initiative.
- Uses discretion in making independent decisions.
Requirements
- Requires a BA/BS in accounting or finance and a minimum of 5 years' experience in a finance/health insurance field capacity and experience with relational databases and mainframe and client server report writers; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
- Experience working post-pay reviews, validation, and recovery processes in the healthcare industry strong preferred.
- Experience managing multiple projects in various stages to completion strongly preferred.
- Experience with medical billing guidelines, and regulations preferred.
- Experience with medical coding systems such as ICD, CPT, and HCPCS strongly preferred.
- Claim processing experience strongly preferred.
- GBD Facets or WGS experience preferred.
Benefits & conditions
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
