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Operations Analyst II - Billing

Operations Analyst II - Billing

Job Locations 
US-VA-Glen Allen
Job ID 
2018-4467

Job Description

Overview

The Operations Analyst II - Billing is responsible for the data analysis, process engineering, report development and generation for the Member Operations department. This position is primarily responsible for developing an extensive expertise in the Wipro Member 360, QNXT and all interface applications, both customized and packaged.

 

An Operations Analyst II - Billing may be the primary contact for one or more system interface applications and is expected to provide a high level of expertise with matters relating to this interface and its functionality.

Responsibilities

  • Develop and analyzes business performance reports for transportation, call center and enrollment data; provides notations of performance deviations and anomalies
  • Perform monthly enrollment process
  • Perform complex data analysis and report writing to identify trends
  • Create complex queries. Apply extensive understanding of database tables, relations, data types and values
  • Develop an expertise in Wipro Member 360, reconciliation modules and other standard report systems
  • Develop an expertise in Premium billing
  • Initiate process improvement and automation from concept to implementation
  • Document applications for use in training, maintenance, and department procedures
  • Research, gather and document requirements for adhoc reporting, project initiatives for new vendor, or business development opportunities.
  • Monitor, test and support system changes for applications
  • Develop advanced knowledge in referral module and interface with transportation scheduling/dispatch system
  • Create and modify enrollment applications entered into Wipro Member 360
  • Analyze issues related to transportation reimbursement process and make recommendations to management for resolutions.
  • Build advanced reports and filters using call center reporting software
  • Ensure programs and business processes meet necessary requirements and are accurately captured in Process Maps and SOPs.
  • Attend meetings, compiles and publishes meeting minutes along with deliverables and other requirements.
  • Confidently works with all levels within the organization to accomplish project goals
  • Performs other duties as assigned

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s degree in Business, Mathematics, Economics, Information Systems or related technical field required
  • Lean Six Sigma certification preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Proficient knowledge of SQL queries to include ability to create and populate databases, perform data normalization, create query analysis, conduct table indexing, perform multiple joins, and comfortable use of functions (average, count, sum, etc.)
  • Healthcare with Medicare and/or Medicaid Operations preferred
  • Strong quantitative, analytical, organizational and problem solving skills
  • Experience in health insurance claims processing, operational and/or data analysis experience; knowledge in database structures and standard query and reporting tools
  • Proficient in statistical use of Microsoft Excel, to include comfortably utilizing functions, developing charts and graphs, inserting formulas, performing Lookups, sorting and filtering data
  • Proficient in Microsoft Access, to include ability to create customs forms, create reports, create lookup and parameters, and utilize function/expression building
  • Proficient knowledge of flow charting/process mapping
  • Experience in process management and process optimization preferred

WORK BACKGROUND/EXPERIENCE

  • A minimum of one year related experience
  • One or more years’ experience as a data, systems or business analyst
  • One or more years business or Healthcare related experience

PHYSICAL REQUIREMENTS

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

 

About Us

Virginia Premier 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.  

 

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

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