Job Description

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Onsite or Remote

Flexible Hybrid

Work Schedule

Monday - Friday, 8:00am - 5:00pm PST

Posted Date

05/06/2025

Salary Range : $76200 - 158800 Annually

Employment Type

Duration

indefinite

Job #

24119

Primary Duties and Responsibilities

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The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and external partners. This role is responsible for gathering and documenting business and system requirements, analyzing and interpreting data to support cross-functional operations, and driving system enhancements to improve efficiency and compliance. The analyst will also support testing, report generation, and documentation efforts related to software and process improvements.

Key Responsibilities:

• Gather and define business and technical requirements to support electronic data exchanges and system enhancements
• Collaborate across teams to design and implement effective business solutions
• Develop documentation including business cases, test cases, and process flows
• Perform data analysis and reporting to support operational decisions
• Lead and support audits, quality control initiatives, and performance improvement efforts
• Coordinate with IT and trading partners to implement Tapestry ISS and other system enhancements
• Ensure compliance with organizational policies and regulatory standards

Job Qualifications

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• Bachelors Degree in Business Administration, Information Systems, Health Care or other related field required
• Minimum of five years experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required
• Minimum of five years experience with CMS processes in a Medicare or Managed Care environment required
• Experience with CMS processes is a plus
• Knowledge of SQL window-based computer environment including MS Office and related programs is a plus
• Knowledge of encounter regulatory reporting and compliance requirements.
• Experience managing vendors to contractual requirements.
• Strong ability to research and resolve encounter issues.
• Strong knowledge of the health care model, capitation and other managed care IPA and provider reimbursement methodologies.
• Strong knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding.
• Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, and meet deadlines.
• Demonstrated ability to analyze and organize complex federal and private insurance regulations.
• Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools.
• Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines.
• Reliability and compliance with scheduling standards.
• Strong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essential.
• Ability to develop, implement, and evaluate methods and systems to improve efficiency.
• Proven skills to lead and facilitate cross-functional workgroups and other meetings.
• Ability to analyze and organize complex federal and private insurance regulations.
• Must be effective at working independently with minimal supervision.
• Ability to support the working hours of the department.
• Ability to travel/attend off-site meetings and conferences.
• Must be customer service oriented, be able to work well individually and as part of a team; and have a strong work ethic.

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