Finance Efficiency Analyst

MCS Puerto Rico; San Juan (PR); On-site; USD 55,000 - 85,000; Full time

Job summary

MCS Puerto Rico in San Juan, PR seeks a Business Analyst to support and improve processes for generating X12 835 ERA files and EOP documents, and to report on performance to management.

The role focuses on analyzing paid claims data, developing reports and dashboards in Excel, and collaborating with cross-functional teams to drive operational efficiency.

Candidates should have a Bachelor's degree and 2+ years in business or database analysis, with knowledge of X12 835 transactions preferred.

Qualifications

• Bachelor's degree in Accounting, Information Systems, Computer Science, or Business Administration.
• 2+ years of experience in business analysis or database analysis and management.
• Experience in the Health Insurance industry preferred.
• Knowledge of X12 835 transactions preferred.

Responsibilities

• Identify and drive process improvements, including reports, analytical tools, and Excel dashboards.
• Support and analyze paid claims data, preparing reports and identifying trends, variances, risks, and opportunities.
• Collaborate with cross-functional teams to gather data, analyze needs, and provide actionable recommendations.
• Perform testing activities to validate changes affecting X12 835 and EOP processes.
• Collaborate with department leaders to implement efficiency initiatives.
• Monitor regulatory compliance and internal controls related to X12 835 and EOPs.
• Track issues impacting reports and coordinate with IT for corrections.
• Keep management informed of significant risks or issues.

Skills

Business analysis

Data analysis

Education

Bachelor's degree in Accounting/IS/CS/Business Administration

Tools

MS Access

Excel

Job description

GENERAL DESCRIPTION:

Support the execution and improvement of processes for generating and sending X12 835 Electronic Remittance Advice (ERA) files and Explanation of Payment (EOP) documents to providers. Report on the performance of these processes to management. Enhance productivity and efficiency in Financial Recovery, Accounts Payable, and Accounts Receivable by identifying and implementing process improvements.

Regular

Exempt

ESSENTIAL FUNCTIONS:

• Identify and drive process improvements, including the development of standard and ad hoc reports, analytical tools, and Excel dashboards to enhance operational efficiency and effectiveness.
• Support and analyze paid claims data and financial information, preparing reports and identifying trends, variances, risks, and opportunities for improvement.
• Collaborate with cross-functional teams from other departments to gather relevant data, analyze business needs, and provide actionable recommendations.
• Perform, document, and coordinate testing activities required to validate changes affecting X12 835 files and EOP’s processes.
• Collaborate with department leaders to identify, develop, and implement operational efficiency initiatives and process enhancement opportunities.
• Support and monitor compliance with regulatory requirements, internal controls, and operational efficiency initiatives related to X12 835 payment reports and EOPs for provider services.
• Monitor situations that may impact the accuracy, timeliness, or delivery of X12 835 payment reports and EOPs, and develop appropriate action plans to address identified issues.
• Monitor X12 835 transaction files to ensure errors are identified, validated, documented, and referred to the Information Technology (IT) department for review and correction.
• Keep management informed of any significant situation, risk, or issue that may affect operational processes, deliverables, or departmental objectives.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor's Degree in Accounting, Information Systems, Computer Science, or Business Administration. At least two (2) years of experience in business analysis or database analysis and management, and preparing utilization analysis and reports, preferably in the Health Insurance Industry.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: Not required.

Other: Knowledge of X12 835 transactions, MS Access and queries is preferred.

Languages:

Spanish – Intermediate (comprehensive, writing and verbal)

English – Intermediate (comprehensive, writing and verbal)

We are an Equal Employment Opportunity Employer and take Affirmitve Action to recruit Protected Veterans and Individuals with Disabilities.