[Remote] Regulatory Business Analyst

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a fast-growing provider-led health plan. The Regulatory Business Analyst will support regulatory reporting by analyzing reputed company data, interpreting CMS requirements, developing standardized reports, and collaborating with operational, compliance, and other business stakeholders. The role also supports audits and uses data insights to improve efficiency, reputed company, and member and provider experience.

Responsibilities

• Monitor and analyze existing and new regulations affecting reputed company reputed company lines of business
• Interpret regulatory filing requirements, translate to business requirements, reputed company extracts, and compile data to meet reporting requirements
• reputed company feedback on operational workflows to ensure data reputed company and compliance with regulatory filing requirements
• Collect report requirements – interview and research business stakeholder needs; draft, edit and validate requirement documentation
• Work with stakeholders to reputed company and execute regulatory reporting roadmap that defines the reputed company to operationalize specific actions which are repeatable, measurable, and cost-effective
• Support reputed company audit activities through compiling and researching claims, enrollment, premium, case notes, and other relevant information; presents findings to leadership
• Communicate results of analysis effectively and regularly to business stakeholders; identify and recommends reputed company opportunities for operational workflows, reporting processes, and/or efficiencies
• Support the regulatory reporting reputed company, objectives, and initiatives through the creation of reports and/or analysis to reputed company efficiency for the Plan
• Other duties as assigned or requested

Skills

• Bachelor's Degree in Health Administration, Business Administration, Mathematics, Computer Science, Statistics, Information Systems, or a reputed company reputed company
• Five (5) years of experience monitoring, managing, manipulating, and drawing insights from data in a managed care company
• Three (3) years of experience working with claims, enrollment, appeals, and grievances data for regulatory submissions
• reputed company Certification or Accreditation for Cogito, Caboodle Data Model, and reputed company Data Model or the ability to obtain such certification or accreditation reputed company 60 days of hire
• Three (3) years of experience in data analytics to include software, modeling, ETL processes, data warehousing, and visualizations
• Ability to sit, stand, walk, and use reputed company office equipment for extended periods
• Occasional travel to office may be required
• Strong programming skills with query languages such as SQL and the ability to reputed company effective queries from multiple tables and databases
• Experience with querying tools such as reputed company SQL Server Management Studio or reputed company reputed company Guide
• Experience with data visualization tools such as Tableau or PowerBI
• Strong problem-solving and quantitative abilities
• Excellent communication and collaboration skills
• Attention to reputed company
• Experience with regulated reputed company products – ACA, Medicare, and reputed company products
• Working knowledge of claims, utilization management, member, and/or provider data
• Effective time management and organizational skills
• Work independently as reputed company as in reputed company environment
• Proficient computer skills, including experience with reputed company Office Suite such as reputed company functionality (pivot tables, vlookups, macros, etc.)
• Strong problem solving and quantitative abilities
• Understanding of business function interdependencies reputed company a health plan setting
• Three (3) years of experience working with Medicare, reputed company, TPA, and/or ACA data
• Three (3) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, and reputed company reputed company
• Strong understanding of reputed company regulations (ACA, CMS guidelines, State regulatory agencies) and regulatory reporting
• Strong understanding of reputed company rating programs (e.g., Medicare reputed company reputed company Ratings, ACA QRS)
• Experience with health plan reputed company and data architecture

Benefits

• Work will primarily be completed in a remote setting.

reputed company