Senior Discovery Bus Analyst


Southfield, USA

Emergent Holdings


keywords: summary,work environment,develop,other duties,education & experience,knowledge,skills,proficiency


Competitive Compensation and Benefits Package

Overview: <br />The Senior Discovery Business Analyst identifies and develops approaches to pursue claims overpayment opportunities. This position tests and qualifies hypotheses using extracted data and validates findings and develops communication plans in conjunction with other business areas and governance bodies.<br /><br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp;</p> <p>&nbsp;</p>
Responsibilities: <br /> <ul> <li>Designs, develops, and documents objective approaches to investigate, analyze, and pursue claims overpayment hypotheses.</li> <li>Continually identifies and pursues new, unique claims overpayment hypotheses to achieve savings targets.</li> <li>Develops and refines high-level data queries to find trends and recovery opportunities.</li> <li>Develops audit questions to identify overpayments and root causes.</li> <li>Quantifies audit results, size opportunities, and estimated recovery savings and maximizes accuracy of savings estimates.</li> <li>Locates applicable CMS and/or internal policies to validate claims overpayment hypotheses.</li> <li>Validates findings with other business units and governance bodies.</li> <li>Completes case audits in a timely manner</li> <li>Participates in maintaining departmental documentation such as desk levels, reports, etc.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Bachelor&rsquo;s degree in a related field.&nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.</li> <li>Certification or progress toward certification is encouraged.</li> </ul> <p>&nbsp;</p> <p><strong>EXPERIENCE:</strong></p> <ul> <li>Three years experience in a related field with demonstrated technical knowledge that provides the necessary skills, knowledge, and abilities required.&nbsp;</li> <li>Prior claims processing and audit experience is preferred.</li> <li>Medicare Advantage plan operation experience.</li> <li>iKA claims system experience is desired.</li> <li>Reporting and data analytic experience preferably with medical paid claims.</li> </ul> <p><em>&nbsp;</em></p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Knowledge of Medicare Advantage plan operations.&nbsp;</li> <li>Strong analytical, reasoning, and critical thinking skills.</li> <li>Strong working knowledge of claims operations, claims process flows for medical/surgical, DME, and pharmaceutical vendors.</li> <li>Strong working knowledge of Microsoft Excel, other Microsoft Office applications, and related software programs.</li> <li>Ability to effectively communicate data results and overall findings to analysis team, other operations, and recovery staff, and other business areas and governance bodies as needed.</li> <li>Knowledge of related laws, legal codes, government regulations, and applicable CMS policy.</li> <li>Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.&nbsp;</li> <li>Ability to write reports, business correspondence, and procedure manuals.&nbsp;</li> <li>Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the public.</li> <li>Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.</li> <li>Ability to define problems, collect data, establish facts, and draw valid conclusions.</li> <li>Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.</li> </ul>