Senior Discovery Business Analyst 8992

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, USA

Emergent Holdings

<p class="p1"><strong>Emergent Holdings is driven by a singular goal &mdash; improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions, and services to support our key stakeholders &mdash; individuals, employers, providers, and strategic partners &mdash; improving the health and safety of the people and places we serve.</strong></p>

keywords: job description,develop,goals,education & experience,initiative,communication,knowledge,skills


Competitive Compensation and Benefits Package

Overview: <br />The Senior Discover Business Analyst identifies and develops approaches to pursue claims overpayment opportunities. This position tests and qualifies hypotheses using extracted data and validates findings and develops communication plans in conjunction with other business areas and governance bodies.<br /><br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp;</p>
Responsibilities: <br /> <ul> <li>Designs, develops, and documents objective approaches to investigate, analyze, and pursue claims overpayment hypotheses.</li> <li>Continually identifies and pursues new, unique claims overpayment hypotheses in order to achieve savings targets.</li> <li>Develops and refines high-level data queries in order to find trends and recovery opportunities.</li> <li>Develops audit questions to identify overpayments and root causes.</li> <li>Quantifies audit results, size opportunities, and estimated recovery savings and maximizes accuracy of savings estimates.</li> <li>Locates applicable CMS and/or internal policies to validate claims overpayment hypotheses.</li> <li>Validates findings with other business units and governance bodies.</li> </ul> <br /> <p>This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.</p>
Requirements: <br /> <p><strong>EDUCATION:<br /><br /></strong></p> <ul> <li>Bachelor&rsquo;s degree in a related field.&nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.&nbsp;</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required.&nbsp;</li> <li>Certification or progress toward certification is highly preferred and encouraged.</li> </ul> <br /> <p><strong>EXPERIENCE:<br /><br /></strong></p> <ul> <li>Three years experience in a related field with demonstrated technical knowledge that provides the necessary skills, knowledge, and abilities required.&nbsp;</li> <li>Prior claims processing and audit experience is preferred.<br /><br /><br /></li> </ul> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:<br /><br /></strong></p> <ul> <li>Knowledge of Medicare Advantage plan operations.&nbsp;</li> <li>Strong analytical, reasoning, and critical thinking skills.</li> <li>Strong working knowledge of claims operations, including knowledge of coordination of benefits (COB), claims process flows for medical/surgical, DME, and pharmaceutical vendors.</li> <li>Strong working knowledge of Microsoft Access, other Microsoft Office applications, and related software programs.</li> <li>Ability to effectively communicate data results and overall findings to analysis team, other operations and recovery staff, and other business areas and governance bodies as needed.</li> <li>Knowledge of related laws, legal codes, government regulations, and applicable CMS policy.</li> <li>Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.&nbsp;</li> <li>Ability to write reports, business correspondence, and procedure manuals.&nbsp;</li> <li>Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.</li> <li>Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.</li> <li>Ability to define problems, collect data, establish facts, and draw valid conclusions.</li> <li>Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.</li> </ul> <br /><br /> <p>The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.&nbsp;</p> <p>We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.</p>