Operations Analyst

US-FL-Lake Mary
Requisition ID
2017-15135
Department Name
Enrollment and Billing

Overview

  Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area.   Our members are our North Star, and our mission is guided by their needs and preferences in ensuring a superior experience and access to the highest quality healthcare when and where they need it. Healthfirst’s commitment to quality and member satisfaction has helped us earn top ratings for HMO health plans in New York City. We know that employees shape our company and connect us to our communities, and we look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers: - Dream Big, Plan Wisely - Break Down the Walls - Think Critically, Speak Up, Deliver with Pride - Inspire Through Trust, Lead By Example - Be Unstoppable   Position Summary:  The Enrollment and Billing Operations Analyst (OA) is responsible for analyzing and summarizing operations data for the enrollment and billing lines of business; including membership, productivity, and quality data. The OA position assists with the maintenance and testing of all system related changes; including workflows, validations, and automated processes. The OA runs and reconciles reports for several lines of business.   Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status  or any other characteristic protected by law.

Responsibilities

 

Duties & Responsibilities: 

 

  • Complete monthly analysis and summary of membership, productivity and quality data that are reported to management
  • Receive and respond to regulatory complaints; interface with internal and external regulatory personnel
  • Execute system batches which are required to implement member modifications to enrollment or billing
  • Complete reconciliation and maintenance of all membership
  • Create and maintain reports to support enrollment and billing processes  
  • Analyze business processes, identify root causes and provide data-based insights and recommendations for process improvements to Enrollment & Billing Specialist and manager
  • Collaborate with manager and LOB leads to understand strategic goals and promote an environment conducive to creativity, change and information exchange
  • Participate in systems testing and validation for various systems including call center programs, databases and other business programs
  • Work directly with other LOBs or business units as a subject matter expert to understand objectives and codependences to ensure consistency across LOBs
  • Write, maintain and execute basic and complex data queries to generate required data sets
  • Additional duties as assigned  

 

Qualifications

 

 

Minimum Qualifications:  

  • High School Diploma or GED from an accredited institution
  • Experience with one or more of the following: querying data using data tables and ACCESS, identifying risks, issues and providing resolution options
  • Experience working in Microsoft product suite, including Outlook, Word, PowerPoint and Excel
  • Manipulation and creation of Excel spreadsheets; including but not limited to standardizing reports across multiple sheets, utilizing vLookups and functions/formulas, creating, using and interpreting pivot tables, filtering and formatting to generate desired results
  • Work experience in health insurance or healthcare environment 

Preferred Qualifications:

  • Bachelor's Degree from an accredited institution
  • Knowledge of MHS and CRM systems
  • Working experience with Medicaid programs and regulations
  • Working experience with NYSoH or Federal Exchange
  • Ability to demonstrate effective verbal and written communication  

 

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