Sr. Business Analyst, Clinical Operations

The Process, Quality and Compliance Department (PQC) within our Clinical Performance Team is responsible for providing analytical and operational support to different departments within clinical operations (i.e., Utilization Management, Appeals and Grievances, Assessments) to maximize productivity, efficiency, while ensuring regulatory compliance is met. The team provides other departments with tools and analytics for compliance and continuous improvement, including reports, operational workflows, and data analysis.

The primary responsibilities of this role will be the development of reports, analytics, and recommendations to ensure continuous process improvement and gap closure. They will be a professional who reviews policies, regulatory requirements, analyzes data and creates recommendations to improve operational functionality. The analyst is expected to successfully lead projects of any size, scope, and level of complexity, directly engaging with senior leaders. It is critical this person is able to use the data they have collected to create/recommend strategies and programs that strengthen the overall operations of the company.

This role is for an independent self-driven contributor who will lead delivery of projects/reports/analytics and may work independently or in matrixed cross functional team. The expectation is this person can lead a workgroup and mentor team members, as required.

Supervision Exercised:

• None

Essential Duties and Responsibilities:

Reports and Tools

• Engages with stakeholders to understand current processes/systems and pain points as well as elicit detailed business needs of/gather requirements for reports and tools.
• Develops reports by querying the database using SQL or any related programming language and analyzing data to ensure accuracy
• Promote new and innovative recommendations to improve accuracy reporting such as robotic process automation (RPA).
• Creates visualizations using Tableau, Looker, Excel

Data Analysis

• Analyzes large sets of data, summarizes, and presents results.
• Develops and analyzes quantitative and qualitative data to meet compliance and operational needs, supporting different departments such as Assessments, Authorizations, Appeals and Grievances, Claims, etc.

Process Improvement

• Partners with clinical operations management to develop and review workflows, to streamline processes and increase efficiency.
• Generates insights and developing recommendations for solutions
• Creates Visio diagrams or other visualizations to use in prototype review sessions

Liaison between Clinical Operations and Other Departments

• Plays a role in developing and managing major clinical operations analytic projects
• Serves as liaison between Business Intelligence team and various departments within Clinical Operations. He/she is expected to translate the business needs into BI requirements for reports, dashboards, and tools.

Working Conditions:

• Standard office conditions.

Required Education:

• Bachelor's Degree in information systems or related quantitative field required (Finance, Business, Computer Science, Mathematics, Economics, or similar)

Required Experience:

• 2-4 years Minimum Experience
• 2+ years SQL Server programming experience
• 2+ years of experience with BI products like, Tableau, Alteryx, Looker
• 2+ years of analytical experience with data or statistical analysis in healthcare industry
• 2+ years of experience in developing and using large relational database modeling concepts and practices (SQL Reporting, or similar)
• Health care industry experience

Desired Experience:

• Experience with robotic process automation (RPA)
• managed care/provider contract modeling experiences a plus

Required Knowledge, Skills & Abilities:

• Advanced knowledge of Excel, including use of Pivot tables, and SQL
• Strong math and analytical skills
• Strong understanding of financial concepts
• Ability to establish and maintain positive and effective work relationships with internal staff, external vendors, and state and federal agencies
• Proven ability to translate business needs into BI requirements
• Proven skills and judgment necessary for independent decision-making
• Strong organizational, time-management and problem-solving skills
• Ability to work independently and within a team environment
• Strong communication skills both written and verbal
• Critical listening and thinking skills
• Strong knowledge of structured query language preferred

Language(s):

• English
• Proficiency in other languages