13 days old

Business Intelligence Analyst II

Umpqua Health
Roseburg, OR 97470
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  • Job Code
    126047475
Full Time - Regular


As a member of the Decision Support Team, you will have the opportunity to provide oversight and apply your analytical and problem solving skills gathering and summarizing statistical data into meaningful and actionable reports. Utilizing a variety of software platforms, the Decision Support Team assists in the preparation and development of robust reporting for the Umpqua Health leadership team, managers and other organizational stakeholders. Under management directive, this individual may evaluate reports and make recommendations which impact business decisions. Position will support the Senior Director of Decision Support, Director of Customer Care and the Manager of Utilization Program.

ESSENTIAL JOB RESPONSIBILITIES:
  • Run queries and create analysis utilizing all data warehouse systems.
  • Provide ad hoc utilization and operational reporting to Clinical Engagement, Customer Care and executive staff.
  • Perform complex financial analysis related to special projects.
  • Perform routine and ad hoc audits of health plan claims data warehouse.
  • Provide analytical reports for the Clinical Engagement, Customer Care, and other work groups as requested.
  • Maintain and update databases and reports used as reference for internal staff.
  • Respond and resolve data inquiries on select subject matters in a timely manner.
  • Compile, organize and analyze data from various sources to serve as research initiatives and to validate Enrollment, Encounter Data and Prior Authorization Utilization.
  • Develop and provide complex reporting and analysis on health plan data.
  • Track population and health trends for purposes of identifying target areas of utilization and case management.
  • Assist data extracts and validation for the purposes of state mandated reporting requirements.
  • Document processes for preparing any monthly or routine reporting.
  • Create tools, spreadsheets and systems to improve prior authorization data analysis and reporting.
  • Oversight of 837I and 837P Encounter Data and Pharmacy Encounter Data processes and obtain signature of submission documents.
  • Response to any Encounter Data OHA memos requesting validation of anomalies/discrepancies at an aggregate level.
  • Provide oversight of daily and monthly 834 Eligibility Files, and reconciliation of 820 Capitation files against eligibility (perc codes).
  • Identify and correct any Enrollment errors, including potential/missed Enrollments.
  • Access the SFTP sites, compile and store posted files.
  • Understand benefit plan coverage, enrollment, claims processing and policies and be able to concisely communicate this information as necessary.
  • Reviews and processes the monthly/weekly reporting (Case Management Incentive, Membership by Tier, Open-Closed, Newborn, etc.).
  • Develops, documents and maintains policies and procedures in relation to data reconciliation, auditing and monitoring.
  • Develops reports to identify trends, outcomes, productivity and Key Performance Indicators for administration regarding; Staffing, Enrollment, Utilization, and Member Appeals and Grievances.
  • Participates in state conference calls and monthly workgroups in relation to job duties.
  • Performs internal audits to ensure processes and procedures are being performed properly.
  • Proven strong project management, multi-tasking and presentation skills.
  • Maintains high level understanding of Medicare and Oregon Health Plan benefits packages.
  • Comply with organizations internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
  • Other duties as assigned

KNOWLEDGE/SKILLS/EXPERIENCE REQUIRED:
  • Bachelors degree in business administration, mathematics, statistics, computer science or finance, or equivalent experience is preferred.
  • Excellent skills in MS office and ability to use all functions of excel required. Additionally, GE Centricity and other medical software preferred.
  • Excellent verbal and written communication skills as well as, outstanding problem solving, organizational and leadership skills.
  • Proven strong project management, multi-tasking and presentation skills.
  • Familiarity with report analysis, and experience working in a finance department preferred.
  • Minimum of 1-3 years of experience in business and financial analytics, health care experience preferred but not required.
  • 3-5 years of experience in OHP enrollment and benefits, specifically CCO related, preferred.
  • Demonstrated ability to successfully work with diverse teams.




PI126047475
Posted: 2020-11-14 Expires: 2020-12-16

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Business Intelligence Analyst II

Umpqua Health
Roseburg, OR 97470

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