Business Analyst III - Risk Adjustment

UPMC Health Plan is hiring a full-time Business Analyst III to support the HCC Risk Adjustment team. This role will work standard daylight hours, Monday through Friday. This role may predominantly work remotely.

Preference will be given to those with the following experience:

• ACA and/or Medicare Part D
• Risk Adjustment
• SQL
• Claims and/or Enrollment
  
  

The Business Analyst III will manage comprehensive analysis of data and information for various UPMCHP products. They will take a leadership role in the enhancement, development, documentation, and communication of identified variances. To successfully perform the role the Business Analyst III must understand the causes of financial & clinical trends and anomalies. The Business Analyst III must use their knowledge and expert understanding of financial, clinical and other information generated by numerous sources to identify opportunities to improve clinical and financial performance. Furthermore, the position requires the ability to articulate these opportunities to internal and external audiences, implement the solutions, and track and monitor progress. These functions must be done while also weighing the practical considerations and potential barriers that need to be overcome to successfully implement new programs and processes.

Responsibilities:

• Ability to extract and define relevant information within patient/member or other business operations data.
• Monitor patient/member access and utilization data against regional and national benchmarks.
• Complete complex financial/operational analysis from beginning to end with minimal supervision or direction from supervisor. Ability to strategize new ways of trending/analyzing data in order to complete analysis.
• Implement and monitor effectiveness of these solutions.
• Must carry out all responsibilities with minimal direct supervision.
• Develop access, utilization and financial/operations reports for forecasting, trending and results analysis.
• Perform in-depth statistical and qualitative analyses related to business operations particularly, patient/member access data and utilization. Ability to explain this analysis to a non-technical audience of both internal and external customers, including executive management.
• Interpret and trend business operations, access and utilization data. Take initiative to investigate variances and derive conclusions and solutions from this data.
• Meet deadlines and turnaround times set by department manager and director. These deadlines and turnaround times will, at times, require the employee to work until project is completed, meaning extended daily work hours, extended work weeks, or both.
• B.A. degree in business, mathematics, statistics, health care, management or a related field. Master's degree preferred. Extensive related experience will be considered.
• 4 years experience in financial and/or medical analysis or successful completion of the FMR Program.
• Experience in health care insurance or health care industry preferred.
• SQL experience highly preferred.
• Claims/Encounters and/or enrollment experience highly preferred.
• ACA or Medicare Part D experience highly preferred.
• Superior computer skills with expert knowledge in Access, Excel, and other financial & statistical software packages.
• Demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis.
• Ability to work in a fast-paced environment a must.
• Ability to manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences.
• Attention to detail is critical to the success of this position, with demonstrated competency in customer orientation and the ability to deal with ambiguity.
• Excellent planning, communication, documentation, organizational, analytical, and problem-solving abilities.
• Advanced mathematical skills.
• Ability to interpret and summarize results of various analyses in a timely and meaningful way.
• Ability to effectively approach problem-solving.
• Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy.
• Possess technical knowledge and expertise in understanding patient access, physician template utilization, healthcare revenues, reimbursement and the correlation to the monthly financial statements.
• Ability to analyze financial & clinical results and to comprehend forecasting models.
• Knowledge and expert understanding of all products and benefit designs of UPMC Health Plan insurance offerings, across all lines of business.
• Well-informed and conversant with general business, economic, and clinical matters.
• Available to work overtime if required.
  
  

Licensure, Certifications, and Clearances:

• Act 34
  
  

UPMC is an Equal Opportunity Employer/Disability/Veteran

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