The Sr. Business Analyst will support the Revenue Cycle Management (RCM) department with financial and operational analysis, new client and vendor implementations, ensuring that existing clients and vendors are meeting their contractual obligations, leading cross-functional process teams, and identifying opportunities for system and or process improvements. The goal of this position is to help drive EBITDA growth through efficiencies within the RCM operations group.
• Monitor operational key performance indicators to identify root cause of poor performing metrics and make recommendations for improvement.
• Monitor financial metrics to ensure the business is performing to plan.
• Monitor health plan rejections and denials and work with claims operations to identify situations where we are receiving CARC/RARC denials associated with fee schedule rate or coding errors.
• Create operational and financial forecasting models.
• Oversee cross-functional processes, ensuring that other departments are following defined processes in a timely manner.
• Partner with external departments to find the root cause of claims with adverse financial outcomes, then work to ensure a remediation plan is put into place.
• Understand and become knowledgeable in Health Plan, Provider and Vendor contracts.
• Prepare PowerPoint presentations for senior and executive leadership.
• Gain a thorough understanding of how our claims system functions including where we can easily configure changes and where we need to modify the system code to implement new clients.
• Create system change requests (CR) as needed to outline new system functionality required to support a new client.
• Support official change management initiative (CMI) processes including the creation of Business Requirement Documents (BRD), RCM sub-team charters, project plans, SIPOC-R diagrams and RACI diagrams.
• Attend meetings and provide project updates on behalf of the RCM.
• Perform operational readiness testing (ORT) as needed once client configuration is created by the business technology team.
• Review RCM vendor invoices and key performance metrics to ensure they are performing according to contract and are being utilized in a cost-efficient manner.
• Monitor RCM spending relative to the budget and call attention to any areas not performing to plan.
Bachelor’s Degree in Business or Management, or experience in the field may substitute some educational requirements. 3-5 years of related experience in working in the health insurance industry and more than 3 years of experience in a financial or business analytics role are required. This position requires a professional demeanor and communication skills as it may be client and vendor facing at times.
• Required technical skillset(s): Excel, Project and PowerPoint
• Proficiency in SQL, Tableau and MS Visio preferred
• Understanding of financial reporting.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.