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Position Description

Arkansas Blue Cross and Blue Shield - EXEMPT POSITION DESCRIPTION

Position:  Revenue Mgmt Business Analyst
Reports To: 
Division:  Executive (0010)
Company:  ABCBS
Location:  Label
Job Code:  004443
Min Salary:   52100
Date Posted:  10/29/2013

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Position Specific Requirements: No position specific requirements.

Job Summary
The position performs financial and utilization analysis for Medicare Advantage business to support revenue management, risk reconciliation, and care management.  The incumbent will be responsible for leading the design, build, analysis, and reporting of data requirements to support revenue management business needs. This role must coordinate with internal staff (Senior Products, vendor management, Enterprise Business Informatics (EBI), finance and IT) to understand requirements for reporting and auditing activities related to Medicare Advantage and Risk Adjustment.

Review of financial and utilization data is critical to support revenue management and care management functions and ensure the Revenue Management goals are met.  The position will serve as the direct link between Revenue Management and EBI; in doing so, they will have responsibility for coordinating reporting elements with EBI and working with multiple vendors to assist with developing solutions for Revenue Management.

The position will work with the Revenue Management Executive and other areas within Senior Products/Statewide Business to strategize, develop, and communicate the specific business reporting requirements to ensure that initiatives are implemented and specific Revenue Management goals are met.

Nature & Scope
Under the direction of the Revenue Management Executive, this position performs in-depth research and analysis and   develops the financial and business reporting solutions for Revenue Management.   The incumbent must work well both independently and with team members.  

Functions included within the scope of this position are performing data extraction, data analysis, report design, report build, providing business recommendations, and draft documentation to support the financial and business reporting needs for Revenue Management. The position will also be responsible for coordinating with EBI and system programmers to ensure that needs are being met from a business and data standpoint. Accurate and timely project status feedback is expected to ensure compliance with established timelines. The position must possess exceptional analytical expertise along with the ability to gain consensus with a varied audience. The position will spend a significant portion of their time creating reports and making presentations to internal staff at all levels.

Minimum Job Requirements

Bachelor's degree (finance, accounting, business, computer science, management information systems) and professional license or medical related field credential (i.e. Registered Health Information Administrator {PHIA}, Certified Public Accountant {CPA}).

Preference will be given to candidates with a Graduate/Masters degree in a health-related or business profession; could include Health Service Administration, Business Administration, or Public Health 


Bachelor's degree, in associated field per above, and analytical experience in risk management, underwriting, medical informatics, disease management, group/physician reporting, or predictive modeling.

Experience in the application of data management and analysis tool including but not limited to: MS Access, FOCUS, SAS, or SQL. Testing of this ability maybe required.

Experience with other PC-based software products including word processing, spreadsheets, and graphic tools.

Experience in Medicare Advantage, CMS requirements, risk adjustment, health plan administration desired, with preference given to those with experience

Comfort and experience presenting to senior-level audiences Demonstration of public speaking ability may be required during interview.

Experience with the implementation of mid-to-large scale systems or projects (projects that take more than 6 months to complete, scan multiple areas and involve numerous people or teams). Knowledge of project management software is preferred.

Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

1. Ability to effectively communicate and coordinate efforts with Senior Products, Case Management, Vendor Management, EBI, vendors and IT departments. This includes the ability to analyze user requirements and generate report specifications as well as the ability to translate data into business context.
2. Accountable for accuracy of all analysis and outputs from reporting projects.
3. Responsible for working with vendor management along with outside vendors to provide and collect data, perform analysis and complete reporting updates as needed.
4. Acquires and maintains MA, Stars, Risk Adjustment and Exchange specific knowledge to initiate, coordinate, and provide expertise in business decision support analytic projects.
5. With oversight from Revenue Management Executive, coordinates process for creating, tracking and addressing any issues with CMS regulatory reporting in a manner compliant with required submission timelines.  Responsible for assisting with data reporting and information request related to 3rd party audits and reviews.
6. Ensure the financial business reporting and regulatory reporting calculations and reports are accurate, timely, and meaningful.
7. Accountable for driving highly entrepreneurial role with some directed oversight. Must take initiative to understand business requirements and create solutions.
8. Participate and provide input for ongoing Revenue Management and EBI meetings.
9. Document business requirements to serve as a basis for EBI and IT development.
10. Assist EBI & IT with project issue resolution during development of any needed reports, applications.
11. Assist the EBI and IT staff in analyzing and researching any reported problems in the financial or operational reports. Ensure that all report user concerns are addressed in an equitable and consistent manner.
12. Ensure the Revenue Management Executive and other SWB Management members are adequately informed concerning the status of all assigned tasks.
13. Ensure that a cooperative and productive climate is maintained with all interdivisional contacts.
14. Assist with periodic internal user testing and training for new Revenue Management projects, reports, tools and applications.
15. Communicate with the Blue Cross and Blue Shield Association and other Blue Plans on best practices in Revenue Management, Stars, Risk Adjustment business / function practices, reports and tools.
16. Ability to stay organized, given demands on time and competing priorities of this environment.
17. Provide guidance and direction to EBI on specific Revenue Management analysis needs, outcomes and business case.
18. Must display excellent oral and written communication skills.
19. Must be able to contribute to effective presentations for executive level audience.
20. Must possess excellent analytical and investigative skills.
21. Other duties as assigned related to Commercial Risk Adjustment

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