Sr. Business Operations Analyst, Healthcare Eligibility Solutions

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range: $78,500 - $95,000

We are seeking a Sr. Business Operations Analyst with strong knowledge of healthcare claims, medical terminology, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL), or Medicare Secondary Payer (MSP). This position will also support new client implementations and existing programs with requirements gathering related to healthcare claims data.

Key Responsibilities:

• Leverage knowledge and expertise in COB/TPL/MSP to analyze claims data.

• Perform detailed analysis to identify trends, patterns to improve existing processes.

• With minimalize supervision conducts analysis to support business decision making

• Assist technical and business leads with requirements gathering and documentation for new implementations and existing program changes.

• Conducts a variety of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.

• Creates complex custom queries to meet reporting needs of internal and external stakeholders.

• Working independently conducts research, analyzes trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, root causes of issues and to support business decisions and strategies.

• Performs QA and UAT as needed.

• Collaborates with technical and business leaders to minimize risks while increasing performance.

• Assists to with review of medical claims pre and post adjudication to identify business improvements and processes.

• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.

• Successfully completes, retains, applies, and adheres to content in required training as assigned.

• Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains.

• Demonstrates Performant core values in performance of job duties and all interactions.

• Correct areas of deficiency and oversight received from quality reviews and/or management.

Knowledge, Skills & Abilities Needed:

• Knowledge of and ability to work with large volumes of eligibility and claims data.

• Working knowledge of healthcare medical and pharmacy claims, including billing requirements

• Experience with Medicaid / Medicare / Other TPL business models and products

• Knowledge of requirements gathering, ETL processing and data matching

• Robust system skills with ability to quickly develop expertise in new systems and applications.

• Advanced skills in Excel, Access, and/or other data analysis applications

• Proficiency with SQL skills to query and test

• Advanced knowledge of X12 EDI Transactions, including, but not limited to 270/271, 277, 837, 835.

• Professional verbal and written communication with good presentation skills

• Able to work independently and meet deadlines with minimal supervision.

• Strong problem solving and communication (written and oral) skills.

• Ability to produce results and maintain a positive attitude in fast paced, dynamic environment.

• Initiative-taking and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen diligence.

• Ability to develop and clearly communicate business rules to production engineers and developer.

• Make sense of complex systems to understand how things work and how problems arise.

• Identify areas for operational efficiency and recommend solutions for process improvements or automation.

Required & Pref