Kaiser Permanente

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Medicare Business Analyst Lead

at Kaiser Permanente

Posted: 2/19/2019
Job Status: Full Time
Job Reference #: 755168
Keywords: financial

Job Description

Business Consulting: Includes analysis/evaluation of business and/or system process and functional requirements, development of business cases, client support during system development and implementation, development and maintenance of service level agreements. Develops relationships with upstream and downstream business partners. Develops/maintains and changes business processes, and understands the business processes of assigned partners and how they relate to our functional areas. Develops and recommends changes to business processes.

Essential Functions:
• Broad application of principles, theories, and concepts in applicable discipline, plus working knowledge of other related fields.
• Uses professional concepts in accordance with company objectives to solve complex problems in creative and effective ways.
• This job is the fully-qualified, career-oriented, journey-level position.
• Demonstrates expertise in functional area business processes and understands assigned and cross functional areas.
• Independently initiates, identifies and coordinates the analysis of complex client needs in project areas such as: new/existing business operating models, innovative approaches to solutions support, market research of emerging or available product functionality and operational readiness assessment.
• Identifies opportunities for increasing business efficiency through improved manual and automated process systems.
• Coordinates the development of comprehensive business cases with cost, service, and benefit dimensions of proposed projects that are used at management and executive levels for funding and scope decisions.
• Accountable for tracking and/or monitor and report for senior mgmt the results of actualization of benefits.
• Plans, coordinates and conducts the analysis of client business processes and functional requirements and the preparation of appropriate documentation to communicate and validate the information.
• Develops cross-initiative integration plans.
• Identifies other initiatives that exist and ensures that efforts are not duplicated.
• Supports a variety of applications.
• Consults on the integration of application systems into the work environment, regarding their operational and training implications.
• Acts as project lead in the coordination of solution development and the implementation of the final product/service.
• Acts as a liaison between business clients and technical staff and/or with development staff throughout the development life cycle.
• May develop project plans.
• Identifies and coordinates within other project managers and implements schedule deadlines as appropriate.
• Manages common resource demands.
• Provides on-going project management and status reporting at all levels.


Basic Qualifications:
• Minimum five (5) years of experience, to include a minimum two (2) years in a consulting role.
• Minimum five (5) years of experience in a healthcare environment or other relevant environment.
• Bachelor's degree in business/health care administration or related discipline OR four (4) years of experience in a directly related field.
• High School Diploma or General Education Development (GED) required.
License, Certification, Registration
• N/A.
Additional Requirements:
• May establish cross-functional task forces.
• Thorough knowledge of platforms of the assigned functional area and multi-area functionality based on assignment.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:
• Certification or advanced qualification by third party association that matches the function or field applicable to the business discipline preferred.

• Ensure effective SOX controls over the Medicare data submission monitoring; including file; encounter and diagnosis level tracking
• Update and maintain Medicare data submission operation process and procedure documentation
• Make contribution to improve and enhance Medicare data submission controls, process and procedures
• Facilitate submission team meetings; monitor Medicare data submission operations; manage and track recurring and ad hoc data submission activities
•  Facilitate meetings with business and regional partners to monitor and coordinate regional Medicare data submission operations
• Communicate with financial reporting team for submission activities and risk adjustment impact
• Collaborate with KPIT for necessary system maintenance and upgrade and review UAT test results
• Prepare Medicare data submission operational report