Business Analyst AHA

Title :  Business Analyst

Location : Philadelphia, PA onsite
Duration or project:  Contract | 3+ Months

• Support the processing team with analysis of claim issues and inquiries. Perform root cause analysis and course correct identified issues for full resolution.

• Work with other plans to resolve issues for members

• Research root cause of incorrectly processed claims, failed DF and RFs. Provide solution and coordinate with appropriate team members to repair the claim and provide re-education to the processor or submit ticket for system enhancement.

• Focus on applying technologies to continuously increase claims process improvements with the use of data, Bots and applications/tools.

• Share this knowledge and skill with other team members to instill across the team the opportunities that they can escalate to process improve. Schedule reoccurring meetings to keep momentum.

• Responsible for evaluating current business processes and developing, implementing, testing and maintaining Technology for more cost effective or quality improvement processing.

• Assist with pulling needed data and assist with the documentation of processes and work procedures.

• Represent Department as SME in meetings, projects and company initiatives)

• Advanced skills in Microsoft Office and with Microsoft platforms (e.g. Excel, Word, PowerPoint) is required

• Working experience with SQL and Access is required.

• Tableau experience is preferred

• Experience with technologies, desktop tools and or Operations processes and technology is helpful

• Perform other duties as assigned.

Qualifications - External

• Experience: 3 years or more of experience in medical claims processing and adjusting or healthcare administration. Expertise in the Blue Squared application

• Technical Skills: Knowledge of medical billing codes (ICD-10, CPT, HCPCS), claims processing software, and a strong understanding of the BlueCard product. Ability to summarize large amounts of data and pivot data in multiple ways

• Analytical Skills: Ability to assess claim data in detail and identify errors or inefficiencies. Possess excellent mathematical skills and have the ability to work independently and within tight timeframes.

• Communication Skills: Strong written and verbal communication skills for interacting with various stakeholders and resolving issues quickly

• Attention to Detail: High level of accuracy and thoroughness in reviewing claims for clients

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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