Financial Operations Analyst Lead- Data Mining...

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

As a part of the Data Mining Overpayment and Operations team, 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.

How you will make an impact:

• Develops and executes complex data analysis.

• Develops strategic report applications from Finance systems.

• Provides decision support and procedural input to ensure that processing efficiency does not compromise internal control mechanisms.

• Interfaces with IT as needed to document and track any needed system enhancements.

• Assists in the implementation of Data Science models within the Finance organization.

• Utilizesclaims expertise to explain business needs to technical partners.

• Represents department in cross functional and executive meetings.

• Uses discretion in making independent decisions.

• Provide direction and guidance to team members, lead efforts on complex projects, and serve as a subject matter expert for the team.

• 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:

• Project management experience

• Experience working post-pay reviews, validation, and recovery processes in the healthcare industry

• Experience managing multiple projects in various stages to completion

• Experience with medical billing guidelines, and regulations

• Experience with medical coding systems such as ICD, CPT, and HCPCS

• WGS claims processing experience

• Experience in payment integrity or recovery operations, including leakage analysis

• Knowledge ofpricing outcomes, and recovery/concept tools (e.g., PICM, ECM, ACR, CI&W).

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.

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.