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Medicare Business Analyst Lead
at Kaiser Permanente
• 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.
• 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
• 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.
• 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