Health Management Analyst

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Glen Allen, USA


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

keywords: job description,research,goals,support,other duties,education & experience,knowledge,skills

Full Time

Competitive Compensation and Benefits Package

Overview: <br />Supports the review and organization of both utilization and case management data used for reporting and auditing purposes. This role assists with researching and compiling appropriate and relevant data and provides feedback for ongoing utilization and case management activities, projects, and program initiatives.<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work can be performed remotely or in an office setting with no unusual hazards.&nbsp;</p>
Responsibilities: <br /> <ul> <li>Assists in the research, identification, analysis, and evaluation of data to validate compliance within the utilization and case management programs.</li> <li>Assists with internal and external audits to include sample authorization compilation, review, and validation.</li> <li>Assists with research, identification, analysis, and evaluation of UM and claims data to assist UM nurse with assigned claims review tasks.</li> <li>Assists with research, identification, analysis, and evaluation of UM and pharmacy data to assist UM nurse with assigned organizational determination review tasks as required.</li> <li>Maintains comprehensive knowledge of business and products to include utilization and case management programs, multiple medical management software systems, and claims payment software system.</li> <li>Monitor&rsquo;s member admissions, enters discharge dates and disposition, refers to needed services in accordance with benefit plan.</li> <li>Assists care managers as needed to mail member letters, contact provider offices, arrange provider appointments and transportation, and other duties as necessary.</li> <li>Assists in monitoring departmental initiatives, outcomes, and objectives to ensure goal attainment within defined parameters.</li> <li>Assists leadership by investigating, reviewing, and recommending innovative solutions which identify problems/root cause of issues.</li> <li>Maintains accurate and complete documentation of required information that meets quality standards.</li> <li>Protects the confidentiality of the member information and adheres to the company policies regarding confidentiality.</li> <li>Performs other duties as assigned.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION:</strong></p> <ul> <li>Associate's degree in Business Administration, Economics, Health Care, Information Systems, or related field.&nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.</li> </ul> <p>&nbsp;</p> <p><strong>EXPERIENCE:</strong>&nbsp;</p> <ul> <li>Two years experience in a related health care field, with the following areas preferred: health care economics, health care policy, health insurance managed care, or the hospital setting.</li> </ul> <p>&nbsp;</p> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <p>&nbsp;</p> <ul> <li>Excellent analytical, planning, and problem-solving skills.</li> <li>Knowledge in the areas of Medicare Advantage, Utilization Management, Case Management, and medical terminology.</li> <li>Excellent verbal and written communication skills with the ability to provide excellent customer service to internal and external customers.</li> <li>Proficient with Microsoft Office products to include Word, Excel, PowerPoint, and Outlook. &nbsp;</li> <li>Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels.</li> <li>Flexibility and ease with changing tasks and priorities.</li> <li>Ability to pay high attention to detail and produce results under multiple deadlines.</li> <li>Verifies accuracy, consistency, and integrity of data; consults with the business owners as needed when validating data for reporting and audits.</li> </ul>