Business Operations Analyst

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. Even in a non-clinical role, Elderplan employees have an opportunity to make a positive impact on the quality of our health plan members' lives.

The Business Operations Analyst provides support to the Network Provider Operations department with daily operations, project initiatives, system updates, special projects, and all regulatory reporting and analysis. The Analyst will audit departmental operations with a focus on data integrity, improving accuracy, and identifying training opportunities for department. Responsible for preparation and submission of all Provider Network Regulatory Reporting. Develop and run extracts to support departmental operational reporting. Lead system upgrades and implementations for the department, and provide technical support as needed. Collaborate with existing technical EPIS structure.

• High school diploma
• Asociates Degree or Bachelors Degree in health/business related field preferred
• 3-5 years of experience in a managed care environment
• Experience with working with technology, systems, provider and/or claims data
• Experience with data, trending, and qualitative analysis
• Familiarity with Medicaid and Medicare regulations
• Experience with geo access analysis and regulatory reporting
• Experience with generating files and reviewing quality for provider directories
• Required: Microsoft Word, Excel, Access, and Visio. SQL.
• Preferred: Visual CACTUS, HealthRules Payor, Quest Analytics, and Optum GeoAccess Suite
• Knowledge of provider data entry and credentialing process
• Ability to utilize Access and SQL to program and execute queries to support data structure and analysis, including tracking and trending on errors
• Excellent verbal and written communciation skills
• Ability to evaluate system set-up and files to determine whether changes are needed to process correctl
• Ability to handle multiple deliverables and to meet strict reporting timeframes
• Knowledge of NY regulatory reports