Job Summary

Virtual Business Analyst

  • Location:
    Lake Oswego, Oregon
  • Job reference:
  • Category:
    Systems Analyst
  • Contract Type:
    Contract/Temp to Hire

Are you interested in working for a company that is a leader in the healthcare industry??
Are you authorized to work in the U.S. without sponsorship?  (We are unable to work C2C all employees must work
Virtual Business Analyst
Portland OR.
Advises and recommends areas of program planning, business requirements management, budget execution and program coordination. Prepares needs assessment. Validates resource requirements and develops cost estimate models. Conducts and coordinates financial, product, market, operational, and related research to support strategic and business planning within the various departments and programs of the client group. Interprets, evaluates, and interrelates research data, and develops integrated business analyses and projections for incorporation into strategic decision-making. Plans and coordinates the development of primary and secondary market research studies in support of strategic planning and specific marketing initiatives, as required, and presents findings of studies to client committees. Provides consultative, advisory, technical, and staff support, as appropriate. Ability to use survey and market research methodologies, systems, and techniques. Experience Level
Primary job responsibility
To support development and operations of Medic-Cal encounter reporting team to ensure complete, accurate, reasonable and timely reporting of encounter data in X12 837 and NCPDP format by following the regulatory agencies (Medi-Cal, CMS) guidelines.
• Responsible for analyzing encounter validation errors encountered within the system (internal quality edit failure) or reported by the regulator (payer denials).
• Identify the root cause of the error and come up with remediation plan to resolve the error.
• Responsible for understanding encounter reporting guidelines (companion guides), identify any opportunities to improve the encounter data reporting.
• Responsible to develop and maintain encounters quality metrics around acceptance, rejections, re-submissions, thresholds etc.
• Responsible for monitoring the encounter data submission to regulators and alert the team when there is a risk of not meeting the data quality, threshold specified by the regulators.
• Responsible for leading the implementation of new encounter reporting guidelines as they become available from the regulatory agencies.
• Work with development team to implement the changes, perform user acceptance testing with the regulatory agencies and document the results.
• Comprehensive knowledge of HIPAA EDI 5010 X12 837, 277CA, NCPDP and 999 file formats.
• Very good understanding of the composition of claims and encounter data for 837 Institutional (UB04) , Professional (1500) and Pharmacy (NCPDP).
• Working knowledge and understanding of relational database environments and writing PL/SQL, SQL scripts for data analysis, troubleshooting, reporting and generating metrics. .
• Excellent verbal and written communication skills and ability to understand the business requirements and translate them into system requirements for development team.
• Team oriented with ability to work effectively across cross functional areas of the organization.
• Excellent problem-solving skills.
If you feel that you are a great match for this opportunity, please apply directly or feel free to contact Nathan at 303-942-2440.
"In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire."

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