LIBERTY Dental Plan is seeking to add Business Analyst to our team. Position will be remote with the ability to report into the Tampa, FL office as needed.
Ideal candidate will have experience working with Florida Medicaid.
This position is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position analyzes complex encounter inbound/outbound process issues, using data from internal and external sources to provide insight to decision-makers. The ability to clearly articulate issues and solutions to team members, management, and external entities is crucial to the success of this position.
- Responsible for documenting, monitoring and analyzing the end-to-end encounter life cycle, both inbound and outbound.
- Identify and interpret encounter data, submission requirements and performance metrics per regulatory and health plan guidelines.
- Research and document all encounter errors in systems/databases; perform statistical and trend analysis.
- Perform root cause analysis of claims/encounters processing and submission issues; communicate with management and provide recommendations.
- Collaborate with other departments (e.g. EDI) on designing and implementing system/business process adjustments as needed to meet encounter data processing and submission goals.
- Communicate with and provide clear documentation to other departments on issues causing encounter pends/denials and potential solutions.
- Collaborate with health plans, clearinghouses and product vendors on encounter-related issues.
- Develop encounter-related reports (e.g. exception reports, root cause analysis outcome reports, etc.) and provide to other departments for error resolution, follow-up and performance monitoring.
- Participate in resolving encounter data and process issues.
- Maintain desktop procedures, workflows and policies & procedures for encounters.
- Recommend balanced approaches to system design and process-oriented solutions to optimize performance.
- Review and research inquiries from regulatory bodies and/or health plans related to submission data, including score cards from health plans.
- Other duties as assigned.
Education and/or Experience:
- Bachelor’s degree in a healthcare field or equivalent experience required
- 4+ years of experience as a Business Analyst or similar role, preferably focused in managed healthcare analysis
- 4+ years of experience in the healthcare payer / health insurance industry.
- 4+ years of experience with ANSI X12 EDI standards for healthcare.
- 3+ years of Florida Medicaid experience.
- Experience with multiple areas of health plan operations (e.g. Member Services, Provider Relations, Claims, etc.).
- Experience with user acceptance testing, training, writing business requirements, and mapping business processes.
- Experience submitting Florida Medicaid encounters is preferred.
- Must be comfortable with SQL, Excel, Access, Visio, PowerPoint, and Word.
- Excellent verbal and written communication and interpersonal skills.
- Strong time management and organizational skills.
- Ability to work under pressure, escalate issues when needed, and manage multiple tasks and deadlines while maintaining accuracy.
- Self-motivated with ability to work independently or as a team.
Environment and/or Physical Factors:
Work is generally performed within an office environment, with standard office equipment available. Sedentary work involves extensive sitting, typing, close range vision most of the time.
Sponsorship and Relocation Specifications:
LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.
No relocation assistance or sponsorship available at this time.