Business Data Analyst, Medicare Advantage

University of California - Los Angeles Health; Los Angeles (CA); On-site; USD 82,000 - 172,000; Full time

Job summary

University of California - Los Angeles Health is seeking a skilled liaison between business stakeholders and Application/IT teams to translate needs into actionable requirements and support system solutions for encounter data operations.

You will gather requirements, analyze data and processes, coordinate testing, and help implement software enhancements while ensuring regulatory compliance and quality standards.

Qualifications

• Bachelor's degree in business, information systems, healthcare, or a related field required.
• 5+ years of experience managing enrollment, claims, or encounters in a Medicare/managed care environment.
• 5+ years of experience with CMS processes.
• 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 healthcare model, capitation, and managed care reimbursement methodologies.
• Knowledge of physician/facility billing practices, CPT/ICD-10 coding, HCPCS.

Responsibilities

• 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 enhancements.
• Develop and maintain interface documentation, policies, and procedures.
• Investigate operational issues and variances, prepare stakeholder reports, and present findings to leadership.
• Support internal and external audits, quality control, regulatory requirements, and operational standards.

Skills

Leadership

Interpersonal skills

Analytical

Problem solving

Prioritization

Oral and written communication

Education

Bachelor's degree in business/information systems/healthcare

Tools

Microsoft Office

SQL

Data visualization tools

Job description

Description

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

Note: This posted position is 1 of 2 positions
available for hire. All applicants will apply through this requisition and if
selected will be hired into one of the available positions.

Qualifications

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