Business Analyst – Membership Billing & Enrollment

ABOUT UCARE

At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It’s a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.

WORKING AT UCARE

Working at UCare is more than just a career; it’s a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization – from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.

BUSINESS ANALYST – MEMBERSHIP BILLING AND ENROLLMENT

Position Description

This position is responsible to perform analyses of business goals, objectives and needs of the business. Plan, document requirements, design business processes, provide recommendations for change in order to improve and support business systems and activities. Provide vendor management, production support and oversight for critical business functions such as enrollment, invoicing, regulatory analysis and hearings and resolution of MB&E related member complaints, appeals and grievances. Provide core project management functions for multiple projects throughout the project life cycle including but not limited to defining MB&E requirements, authoring various project related documents, managing communication and relationships, and completing project validation through test planning and performance of testing. Serve as liaison between the business and technical/program resources. Collaborate with MB&E team to triage and troubleshoot solutions post-implementation. Ensure requirements and solutions conform to department, corporate, industry and regulator standards as specified. Provide ongoing support to day to day key functions and initiatives of business units. Participate in the quality assurance plan and execute cross-department activities related to audit, quality assurance and testing of existing and new processes. Specific duties and responsibilities include: Collaborate with vendors, business clients and program/technical teams to perform analysis, define business requirements, and implement innovative solutions that solve business problems or meet business objectives from a strategic and tactical perspective. Coordinate key vendor and business project/initiative activities. Drive project effort and facilitates project related meetings. Partner with upstream and downstream implementation to ensure seamless and predictable outcomes. Maintain a comprehensive, sustainable project management process and work collaboratively with teams to support the business owner. Provide predetermined status updates to monitor progress, deliverables, milestones, timelines, resource allocation, problem solving strategies and outcomes that will result in successful implementation of projects. Collaborate with leaders to identify and implement repeatable and sustainable process improvement efforts involving enhancements to core MB&E processing systems. Provide vendor oversight and process oversight for electronic data interface (EDI), vendor support functions; i.e. ikaSystems, HealthLOGIX, Wells Fargo, to increase administrative effectiveness and efficiencies. Provide production support and vendor oversight for critical business functions for both billing and enrollment processes. Drive resolution of billing and enrollment related member complaints, appeals and grievances and provide timely follow through to appropriate areas and regulators. Develop and maintain a thorough working knowledge of UCare contracts (Medicare, Medicaid and Commercial) as they impact billing and enrollment functions. Plan, organize and lead billing focused/targeted initiatives. Distribute pertinent information and oversee work assignments and monitor daily workflow to ensure turn-around times and regulatory requirements are met. Develop and maintain a thorough working knowledge of the vendors and systems (Medicare, Medicaid and Commercial) utilized to support billing and enrollment functions. P rovide mentoring and one on one functional support to the MB&E team. Partner with IT management and MB&E to define project direction; develop project plans with technical and project management staff. Gather and translate business requirements and apply strategic and tactical business direction into technical requirements used for driving technical improvements, enhancements, or creation of new applications. Communicate project/initiative and scope, and negotiate with teams to work through constraints and alternatives. Support process and individual quality reviews to ensure staff’s technical accuracy and competence. Provide feedback and follow up support to department managers and trainers. Assist in the development and maintenance of department policies and procedures consistent with the goals and objectives of the organization. Supplement policies and procedures with Step by Steps (SBS) including functional and process level instruction and illustration. Communicate changes in policies and procedures to team and management in a timely manner. Negotiate and manage project scope, progress, and MB&E expectations. Communicate project updates as needed to management and MB&E teams. Assist program/technical team post-implementation for production support and ensure solutions continue to meet business requirements. Collaborate with department trainer to develop ongoing training to business units to empower ownership of solutions and day to day work effort. Remain current with project management methodologies, development procedures and innovative solutions for key business initiatives. Complete key functions as assigned by MB&E management in an accurate and timely manner. Committee / work group representation as assigned.

Education

Bachelor’s degree in business, accounting or related field; demonstrated experience may be considered..

Required Experience

Five years of business analysis experience within health plan Operations or IS. Two years of project implementation experience. Experience in business process improvement. Advanced level skill in Access and Excel.

Preferred Experience

Health Plan Operations experience in Enrollment and/or Membership Accounting. Process improvement and/or Six Sigma experience. Health Plan Operations experience in Enrollment and/or Membership Accounting. Experience working with CMS/DHS regulations. Strong critical thinking and analytic skills.

THE UCARE DIFFERENCE

UCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you’ll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual’s ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you’re looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.