Business Systems Analyst
Cambia Health Solutions

Job Info

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Business Systems Analyst - Risk ManagementRemote

The Risk Management BSA is responsible for complying with CMS mandates to submit Enrollment, Medical Claim and Pharmacy Claims data for Risk Adjustment.

Responsibilities:

• Extracts required information from the source systems into a staging area and performs validation checks based on CMS Edge Server Business Rules.
• Submits data to the Edge Server via an established translation process. 
• Reviews data validation reports that are received back from CMS and any errors are investigated and corrected prior to data being resubmitted.
• Communicates with internal/external customers to resolve any errors within the source systems for any of the above areas.
• Encourages ongoing innovation and looks for opportunities to enhance the quality and efficiency of departmental processes.
• Assists in the training and communicating system changes for end-users and other affected staff.
• Schedules, organizes and prioritizes work to ensure timely completion of all assigned activities.
• Maintains process documentation and ensures data submission and validation activities align with CMS guidelines.

Additional Responsibilities for level II

• Partners with Risk Management leadership to prioritize data submission activities and resolve issues in a timely manner.
• Creates new data queries for the data submission process.

Additional Responsibilities for level III

• Communicates to the enrollment, medical claims, pharmacy claims, and supplemental condition code business partners as to what the requirements are for CMS submission.
• Completes technical peer review of process improvements and ad hoc departmental projects.

Minimum Requirements

• Experience aggregating, reviewing and extracting data from various sources to create larger, more complex data sets.
• Good research and problem solving skills including the ability to determine action steps and remediation actions to resolve issues.
• Ability to accurately complete activities within established deadlines. Ability to work under pressure and partner with others.
• Good written and verbal communication skills including the ability to work with internal and external partners.
• Proficiency with Microsoft Office software programs and general experience database query tools.
• Ability to update process documentation to ensure activities and outputs align with CMS guidelines.
• General knowledge of medical terminology and procedure coding.

Additional Minimum Requirements for level II

• Ability to identify problems, develop solutions and implement actions with minimal supervision.
• Ability to develop and modify data queries for use in the CMS data submission process. Works with internal partners to test and validate the effectiveness of new or modified queries.

Additional Minimum Requirements for level III

• Tracks and monitors CMS data submission guidelines. Reviews and verifies updates made to process documentation align with data submission guidelines. Acts as a resources to others on the Risk Management team.
• Updates business partner groups (enrollment, medical claims, pharmacy claims, etc.) on annual changes to CMS submission requirement.

Normally to be proficient in the competencies listed above:

• The Risk Management BSA I would have a Bachelor's degree in Business, Data Analysis or other related field plus 2 years' experience with data analysis, process modeling or equivalent combination of education and experience.
  

• The Risk Management BSA II would have a Bachelor's degree in Business, Data Analysis or other related field plus 2 - 4 years' experience with data analysis, process modeling or equivalent combination of education and experience.
  

• The Risk Management BSA III would have a Bachelor's degree in Business, Data Analysis or other related field plus 5 - 7 years' experience with data analysis, process modeling or equivalent combination of education and experience.

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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