Operations Business Analyst

Career Opportunities: Operations Business Analyst (24775)

Requisition ID 24775 - Posted 01/10/2025 - CareOregon - Full Time - Permanent - Portland - Multi Location (18)

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Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Title

Operations Business Analyst

Requisition #

24775

Exemption Status

Exempt

Management Level

n/a

Direct Reports

n/a

Manager Title

Operations Manager - Provider Network

Department

Provider Relations

Pay and Benefits

Estimated hiring range $71,340 - $87,200 /year, 5% bonus target, full benefits. careoregon. org/about-us/careers/benefits

Posting Notes

This is a fully remote role, but you must reside in one of the listed 9 states. You must be able to accommodate PST business hours (M-F 8-5pm).

Job Summary

The Operations Business Analyst is an advanced team resource providing technical and process assessments. The position works as a cross-functional team member and liaison between the assigned department, IS and external vendors to analyze problems, define business requirements and recommend solutions. The position is responsible for all aspects of the life cycle of development from requirements gathering to implementation and ongoing support. Additionally, the position applies process improvement methods by effectively utilizing organizational assets and applying best practices. Areas of focus and specialization vary by department.

Essential Responsibilities

• Perform existing systems analysis and design new systems.

• Gather and define functional business requirements for new and existing processes.
• Document business requirements, business methodologies, systems flow, data flow and functional system design.
• Translate business needs and requirements into actionable tasks for analysts and IS teams.
• Collaborate with analysts and IS teams to implement changes; participate in User Acceptance Testing.
• Monitor and improve the quality of reports that are produced.
• Monitor, maintain and improve project quality and implement continuous process improvements.
• Develop ad-hoc reports using Microsoft applications and provide analysis.
• Provide project status reports as required.
• Monitor and provide ongoing system support and guidance to department staff.
• Monitor and resolve support requests using ticket system; escalate requests as necessary.
• Communicate the status of pending requests to stakeholders.
• Communicate the perspective of business units for projects and implementations.
• Effectively develop, manage, and maintain productive customer relationships at all levels.
• Engage senior leaders as thought partners on an occasional basis.
• Present the results of analysis to executive sponsors as needed.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• 3 years' experience with Medicare and/or Oregon Medicaid
• 2 years' experience related to business analysis, process improvement, systems testing, and/or requirements gathering for systems implementations

Preferred

• Provider Network Operations department roles: 3 or more years' experience working directly in provider network systems (for a provider or health plan), such as credentialing platforms, online provider portals, contract management systems
• Claims department roles: 3 or more years' experience working directly with claims as a Biller (for a provider) and/or claims processor (for a health plan)
• Experience performing operations business analyses within the department's area of focus
• Experience working with QNXT, or similar Claims/Authorization processing platforms
• Exposure to business modeling tools (i. e. , Visio) and various methodologies / frameworks such as CMMI, RUP, Six Sigma

Knowledge

• Advanced knowledge of continuous improvement and Lean methods applicable to health care industry
• Working knowledge of Microsoft products including Outlook, Word, Excel, and PowerPoint
• Working knowledge of the Centers of Medicare and Medicaid Services (CMS) guidelines as they relate to dual-eligible advantage plans
• Working knowledge of Oregon Health Plan (OHA) guidelines

Skills and Abilities

• Ability to use or quickly learn to use business process modeling and mapping tools (e. g. , Visio, Smartsheet, etc. )

• Ability to lead continuous process improvement to achieve desired and sustainable results
• Ability to read, analyze and interpret professional journals, technical procedures and governmental regulations
• Ability to bring structure to projects containing ambiguity
• Ability to prioritize multiple projects and strategic objectives and meet deadlines
• Ability to identify and remove barriers to accomplishing project requirements
• Ability to work well under pressure with frequent interruptions
• Ability to remain calm and respond in a professional manner when faced with difficult situations
• Strong written, verbal and presentation communication skills
• Ability to communicate effectively with all levels of leadership and staff
• Ability to communicate effectively with business and technical personnel

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment and/or mobile technology

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home (may vary by department)

#MULTI

Candidates of color are strongly encouraged to apply.