Business Analyst, Sr.

Job Title: Business Analyst, Sr.

Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com.

RESPONSIBILITIES:

Engagement Description:

• This engagement requires a highly skilled Risk Adjustment Business Analyst who can bridge regulatory requirements with operational execution across Medicare Advantage and other risk-bearing programs.
• The analyst will help ensure compliance with CMS guidelines, minimize operational risk, and contribute to the overall success of Risk Adjustment activities by the plan.
• The ideal candidate will bring a strong foundation in risk adjustment), reviewing and translating regulatory requirements and helping the business area implement compliant and optimal solutions.
• Additionally, the Business Analyst will support industry level research to ensure that best practices are implemented that minimize risk, while maximizing health outcomes for the organization’s members. 
• Success in this role demands cross-functional collaboration, critical thinking, and the ability to operate in a fast-paced, high-stakes environment.
• This engagement directly supports our organization’s ability to remain compliant, optimize RAF accuracy, and achieve sustainable reimbursement outcomes.

QUALIFICATIONS:

Top 3 Required Skills/Experience:

1. Business Requirements Gathering:
   1. They research, interpret and understand CMS regulations and applicable laws pertaining to risk adjustment
   2. They collaborate with stakeholders to gather and document business requirements for risk adjustment programs, translating them into functional specifications for business teams.
2. Risk Management:
   1. They develop and implement risk assessment and monitoring review processes to mitigate and/or remediate risk within the risk adjustment space
   2. They track and manage corrective action plans to address identified compliance risks and deficiencies
3. Process Improvement:
   • They analyze existing controls and processes against guidance to enhance and strengthen those processes and controls in alignment with current guidance and best practices.
   • They support the documentation, implementation and tracking of  controls and systems which create enhanced efficiency and effectiveness.

Required Skills/Experience:  

• Technical Skills:
  • Data Analysis: Ability to analyze large datasets to identify trends, patterns, and anomalies related to risk adjustment and compliance. This includes:
    • Using data analysis tools and software
    • Interpreting data to understand risk adjustment and compliance issues
  • Business Intelligence (BI) and Reporting: Experience with BI tools and reporting platforms to create dashboards and reports for monitoring risk adjustment performance and compliance.
  • Proficiency in MS Office applications
• Business Skills:
  • Risk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific compliance requirements
  • Regulatory Compliance: Knowledge of healthcare regulations and laws, including HIPAA, and how they apply to risk adjustment data and processes
  • Business Process Analysis: Ability to analyze existing business processes, identify inefficiencies, and recommend improvements to enhance compliance and performance
  • Problem-solving: Ability to identify and assist with resolving complex compliance issues related to risk adjustment data and processes
  • Communication: Excellent verbal and written communication skills to effectively communicate with internal teams, external partners, and regulatory bodies
  • Attention to Detail: Meticulous attention to detail to ensure accuracy and compliance in data and processes
  • Research: Ability to review conduct research and review of regulatory guidance to interpret and implement
  • Project Management: Ability to manage projects related to risk adjustment initiatives and compliance projects, requiring skills like defining scope, identifying resources, and scheduling
  • Stakeholder Management: Ability to collaborate effectively with various stakeholders, including clinical staff, IT teams, and management
  • Critical Thinking and Decision-Making: Ability to analyze situations, make informed decisions, and develop solutions to complex problems
  • Adaptability: Ability to adapt to changes in regulations and risk adjustment programs

Preferred Skills/Experience: 

• Prior roles in a compliance and/or regulatory department

Education/Certifications – Include: 

• Bachelor’s degree in healthcare administration, business, or a related field with strong quantitative and analytical coursework
• Compliance related certification, e.g., CHC, CCP would be a plus, not required

OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/