COMPANY OVERVIEW At Harbor Health, we are enhancing healthcare in Austin through strategic collaboration and innovative practices. We are looking for individuals to help us develop a member-focused experience that integrates comprehensive care with a modern payment model. If you are ready to contribute to a dynamic environment where your expertise is valued, we invite you to consider becoming a part of our team.
POSITION OVERVIEW The Business Analyst, Health Plan Systems position drives business requirements, process improvements and system enhancements. Uses advanced knowledge of healthcare data, systems, and operational processes to serve as subject matter experts to support health plan growth and improvement initiatives for member enrollment and member/group billing. Maintains knowledge of regulatory requirements that impacts business direction. At the direction of the Manager of Health Plan Operations drives resolution of issues and oversees activities related to resolution of issues impacting member and group satisfaction.
POSITION DUTIES & RESPONSIBILITIES
Leads and drives operational performance improvement initiatives.
Develops, reviews, and approves business requirement documents on assigned subject matter.
Develops test cases across multiple domains and performs/validates test cases during UAT.
Documents and issues for associated vendors.
Serves as subject matter expert in support of enrollment and member/group billing systems.
Engages with IT, health plans, and vendor partners to resolve issues and optimize encounters performance.
Performs root cause analysis of enrollment and member/group billing processing.
Develop recommendations based on data and industry knowledge. Collaborates across departments to design and implement systems changes to ensure members and group high level of satisfaction.
Analyzes data to verify outcomes of initiatives.
Develop reports and distribute them to appropriate departments for error resolution, follow up, and performance monitoring.
Monitors’ vendors enrollment and billing processes, contractual compliance, and SLAs
Work with the TPA to develop business specs at the start of a technical project.
Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work.
Develops detailed knowledge of the functionality of the system used for enrollment and billing ACA/IFP members.
DESIRED PROFESSIONAL SKILLS & EXPERIENCE
Three or more years of experience in member enrollment and member/group along with data analysis
3+ years of managed care experience
Expert knowledge of healthcare member and billing data
Strong data analysis skills and experience writing basic to advanced SQL
Strong interpersonal and communication skills
Proficient with verbal and written presentation of complex operational information
Prior experience in developing RFIs for vendor selection
Knowledgeable with CMS requirements around IFP/ACA business
2+ years’ experience in developing test cases and performing UAT
3+ years of IFP/ACA enrollment requirements
Significant working knowledge of IFP/ACA enrollment systems (i.e., Health Sherpa)
Previous experience with the HIPAA 834 and understanding of the transaction’s syntax
Preferred:
Familiarity with Texas Department of Insurance (TDI) rules, regulations, and law
Experience in the Start Up phase of a health plan
Strong Excel and Power Point background
Background in vendor implementations
Experience in bringing an IFP/ACA product to market
WHAT WE OFFER
Opportunity to shape, develop and mentor individuals to grow their career and impact their lives
Collaborative and dynamic work environment
An organization made up of people who are passionate about changing the healthcare landscape
Competitive salary and benefits package
Professional development and growth opportunities
A transparent and unique culture
Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive environment for all clinicians and teammates and actively encourage applications from people of all backgrounds.
