Virginia Premier Health Plan, Inc.

Have you applied with us before?

Business Analyst II - Cost Containment

Business Analyst II - Cost Containment

Job Locations 
US-VA-Richmond
Job ID 
2017-4300

Job Description

Overview

This position is responsible for supporting the Cost Containment Unit in drafting, documenting and gathering business and technical requirements related to initiatives which support the Unit’s efforts to provide corporate services in Recovery and Cost Avoidance as related to Claims payments for all lines of business. The individual will gather information from all related stakeholders, maintain project management updates, develop reporting tools, draft process flows and document Standard Operating Procedures. The position will require collaboration across corporate matrices. The position will entail representing the team as a subject matter expert on projects and content related to the team’s activities across all lines of business. Will act as a liaison between Virginia Premier (VPHP) and the external Cost Containment vendors employed, assuring compliance with all regulations while maximizing efficiencies and return on investment. Participate in developing new opportunities and engage in new vendor selection as required.

 

Responsibilities

  • Partner with Manager and other Leadership to identify and develop overpayment recovery and cost avoidance opportunities, refine and maintain after delivery.
  • Develop, compile and distribute reports related to Cost Containment initiatives.
  • Draft newly created process flows and maintain present process flows and related documentation.
  • Draft Standard Operating Procedures, Process Maps and maintain updates to changes made on existing documents under guidance of Manager.
  • Develop data driven tools to analyze vendor effectiveness and return on investment for each contractual arrangement and for the unit as a whole.
  • Research, gather and document requirements for adhoc reporting, project initiatives and new vendor or business development opportunities in compliance with all contractual obligations, including DMAS and/or CMS.
  • Perform data analysis for projects, including cost benefit, return on investment, trend analysis, bench marking and gap analysis, and outcomes metrics measurement.
  • Document all project status updates including contact information, overview, barriers, next steps and accomplishments.
  • Maintain oversight of Project Plans ensuring all updates are made in timely fashion. Follow up on assigned tasks which are near or have exceeded due dates.
  • Document and maintain all task schedules and related deliverables via SharePoint repository.
  • Ensure all reports have been compiled and delivered to appropriate parties as scheduled.
  • Perform root cause analysis and coordinate corrective actions through Director and responsible parties.
  • Create, maintain and oversee Vendor Contract and process flow encyclopedias ensuring all documentation will meet requirements of Audits performed.
  • Act as liaison between vendors and VPHP as required. Escalate issues of concern and monitor vendor effectiveness.
  • Gain understanding of all VPHP systems and tools including DBMS, SQL, Access, Excel, IDX, QNXT, Visual Studio, Data Warehouse extract tools, automation tools as well as SFTP protocols.
  • Document all technical specifications for new implementations of vendor software including testing assistance in scenario development and system testing.
  • Provide support in the development, implementation and oversight of Program Integrity capabilities to establish Fraud and Abuse controls. Maintain and improve as directed.
  • Profile vendor outcomes, claims payment discrepancies and system or process inefficiencies; perform data analytics to determine root cause and investigate system configuration or process changes required for corrective action.
  • Draft Change Gear submissions for approval by senior level analysts or Manager in requesting configuration or process changes.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

 

  • Bachelor’s Degree in Business, Finance, Health Administration, Mathematics, Information Systems or related fields of study.

SPECIAL KNOWLEDGE AND/OR SKILLS

 

  • Understanding of Medicare and/or Medicaid regulations with regard to health insurance claims processing and payment methodologies preferred.
  • Proficiency in Microsoft Office Products with emphasis on Excel (must be able to create formulas and analyze data and strong use pivot tables).
  • Demonstrated ability in compilation, analysis, and presentation of data.
  • Ability to work independently and manage multiple tasks and priorities.
  • Ability to effectively communicate both verbally and in written form with various levels of employees throughout the organization.
  • Work effectively in a fast past paced, collaborative team environment across the corporate spectrum with attention to detail orientation.
  • Knowledge of DBMS, TSQL, Access or another structured query language or related Business Intelligence tool.
  • Windows Operating Systems: Windows 7 Professional.
  • Experience in supporting end users in a corporate environment.
  • Project Management Skills and experience in use of Project Management related tools.
  • Strong documentation and time management skills.

WORK BACKGROUND/EXPERIENCE

 

  • Required Minimum 2-5 years of experience data analysis, project management, process improvement and/or report development role.
  • 1-2 years experience in a business/reporting/systems analysis role. (Healthcare preferred)
  • Project Management experience combined with PowerPoint presentation development.
  • Experience in development of reporting for Executive/Senior Leadership.
  • Demonstrated skills in SharePoint.
  • Vendor relationship coordination experience.

 

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

Need help finding the right job?

We can recommend jobs specifically for you! Click here to get started.