Business Analysis Manager (Remote)

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview
The Business Analysis Manager provides both operational support to, and analysis of, all Tapestry claims processing-related system configuration activities. The Business Analysis Manager creates, updates, tests and maintains system configuration relating to benefits, fee schedules, provider payment contracts, Division of Financial Responsibility (DOFR) agreements, and claims adjudication logic. The ACO Business Analysis Manager ensures successful configuration, integration, and accurate and timely payment of claims. Consults appropriate internal partners on issues of interpretation/clarity.

Locations
Stanford Health Care

What you will do

• Executes world class practices of service and patient care in support of C-I-CARE standards.

• Uses C-I-CARE templates and the following components for all communication with patients and staff:

• CONNECT with people by calling them their proper name, or the name they prefer (Mr., Ms., Dr.)

• INTRODUCE yourself and your role

• COMMUNICATE what you are going to do, how long it will take, and how it will impact the patient

• ASK permission before entering a room, examining a patient or undertaking an activity

• RESPOND to patient’s questions or requests promptly; anticipate patient needs

• EXIT courteously with an explanation of what will come next

• Work closely with Information Technology team to translate benefits, DOFRs, fee schedules, provider payment contracts and associated details into system configuration parameters.

• Responsible for effective management of Code Editing System (CES), to include pro-active evaluation of edit functionality/accuracy, review and functional testing of system updates.

• Document code edit issues and trends and assist with problem solving and solutions. Identify recurring claims/billing errors and trends and reports them to management when necessary.

• Ensure compliance with the health plan policies for complete, accurate and consistent application of benefits.

• Ensure compliance with provider and health plan contractual agreements around fee schedules and DOFRs (both upstream with health plans and downstream with delegated provider groups.)

• Develops processes to analyze, design, and perform user acceptance testing on benefits, DOFRs, fee schedule, and provider payment contracts.

• Provides assistance to all departments on claims payment-related issues.

• Develops, documents and executes user acceptance test plans for configuration testing and validate accuracy of data loaded.

• Maintains detailed knowledge and understanding of the claims processing system rules relative to claims payment.

• Maintain up-to-date knowledge of regulatory changes impacting configuration (e.g. ICD-10, ASC, DRG, CPT, HCPCS code updates, CMS coding rule changes, etc.)

• Remain updated on all member and provider policy changes made by the health plan, Stanford Health Care Advantage, CMS and/or the State

• Compile information and prepare reports and analyses of results of system configuration findings including appropriate recommendations

• Assist all internal and external stakeholders with reports as requested

• Act as a liaison with the Claims, Provider Relations, UHA/SHC and Patient Financial Services departments to facilitate effective communication regarding coding and billing issues.

• Assist in assuring compliance with local, state, federal coding standards.

• Supervises and manages business analyst(s) focused on system configuration analysis and issue resolution tasks

• Delegates work to business analyst(s) and monitors performance against expectations

• Ensures adequate staffing, training and tools to support functions and responsibilities of the ACO Business Analysis team

• Performs other duties as assigned and participates in organization projects as assigned.

• Adheres to safety, P&P’s (if applicable), HIPAA and compliance policies.

Education Qualifications

• High School Diploma or GED Required

Experience Qualifications

• Advanced skill level in Excel Required

• Knowledge of and working experience with ICD-10, CPT and HCPC