Business Data Analyst, Medicare Advantage

In this role, you will serve as a liaison between business stakeholders and Application/IT teams, translating business needs into requirements and supporting system solutions for encounter data operations.

You will:

• Gather and document business and functional requirements, process flows, business cases, system specifications, test cases, and other SDLC materials.

• Analyze data, business processes, electronic transactions, and file exchanges to identify system gaps and opportunities to improve processes.

• Coordinate testing with trading partners and certification authorities.

• Support the design, development, testing, and implementation of software and Tapestry ISS enhancements.

• Develop and maintain interface documentation, policies, and procedures.

• Investigate operational issues and variances, prepare stakeholder reports, and present findings and recommendations to leadership.

• Support internal and external audits, quality control, regulatory requirements, and operational standards.

Salary Range: $82,434 - $171,779/annually

We’re seeking a self-motivated and results-driven individual with:

• Bachelor’s degree in business, information systems, healthcare, or a related field required

• 5 or more years of experience managing enrollment, claims, or encounters in a Medicare or managed care environment required

• 5 or more years of experience with CMS processes required

• Computer proficiency with Microsoft Office, SQL, and data visualization tools

• Knowledge of encounter regulatory reporting and compliance requirements

• Experience managing vendors to contractual requirements

• Ability to research and resolve encounter issues

• Understanding of the healthcare model, capitation, and other managed care IPA and provider reimbursement methodologies

• Knowledge of physician/facility billing practices, CPT coding initiatives, ICD-10 coding standards, and revenue and HCPCS coding

• Strong leadership, interpersonal, analytical, problem-solving, and prioritizing skills

• Excellent oral and written communication skills

• Ability to develop, implement, and evaluate methods and systems to improve efficiency

• Ability to work well independently as well as part of a team