Sr Quality Business Analyst
Duties Include
1. Review transactions to ensure accuracy of transaction and system processing. Provide timely documented feedback on issues identified at the processor and/or system level and execute escalation procedures if applicable.
2. Ability to assess CMS Medicare Advantage regulations and required controls and incorporating what is required into the specifications and/or documentation.
3. Identify process improvements and develop workflow and/or system recommendations.
4. Support CMS program audits; including research claims related issues/questions and preparation of appropriate audit responses as well as represent IBX in the audit presentation to CMS.
5. Support assigned projects related to Medicare Advantage products, maintain appropriate documentations at a task level, monitor deadlines and service as a technical liaison when appropriate.
6. Evaluate/ test new or modified processes and procedures to verify that the new Medicare Advantage programs or program changes are functioning as intended and conform to established policies. Maintain detailed testing notes, cases, and outcomes to support all findings.
7. Develop and maintain user documentation ensuring the most current information is available to the production areas.
8. Communicate effectively in writing and verbally with in work groups and internal and external customers.
9. Attend internal and external education training to achieve and maintain proficiency on all systems.
· Associate degree or minimum two-year Medicare Advantage work-related experience, bachelor’s degree preferred.
- Knowledge of systems, process flows, regulatory impacts, and timelines to ensure requirements, testing and implementation are in compliance across operational disciplines.
- Ability to compile detailed system requirements, reporting and data mining to support business needs that meet the need.
- Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer.
- Superior written and verbal communication skills are required to provide business units with information and tools to support system modifications and/or new installations.
- Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result.
- Minimum three (3) or more years of auditing, quality review or transaction processing experience
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.