Job Details
Job Location
Smithfield, RI - Smithfield, RI
Position Type
Full Time
Education Level
Bachelors Degree
Travel Percentage
None
Job Shift
Daytime
Job Category
Professional / Experienced Description
This position serves as a critical role for regulatory reporting, ensuring stakeholders make sound business decisions that directly impact Neighborhoods reportable metrics. The Regulatory Reporting Analyst Lead will be responsible for providing the necessary analysis based on integrated healthcare data to deliver high quality solutions to meet our stakeholders needs. They act as a liaison to the stakeholders, coordinate the requirements efforts of multiple projects and are responsible for mapping business processes and recommending business solutions to operational issues. They provide guidance and act as a resource to Analysts and Developers whose primary purpose is collecting, analyzing, and communicating health care and business information to internal and external stakeholders, as well as extracting health care information in a format deliverable to regulatory agencies.
Duties and Responsibilities
Key responsibilities include, but are not limited to the following:
Determines impact of business process and system changes to development of reporting.
Serves on governance committee to evaluate proposed business process and system changes as needed.
Provides training and acts as a primary consultation resource for analysts and developers within the team.
In conjunction with the Senior Manager, oversees deliverables of staff analysts and developers to ensure auditable documentation and accurate reporting.
Manages and coordinates the development and implementation of requirements for new and updated reports from start to finish.
Contributes to development of business requirements, functional requirements, process flows, reference materials, user guides and code release artifacts as appropriate.
Assures quality and integrity of data collected, analysis performed, and reports generated.
Ownership of reporting facilitation process and developing procedure for the audit process
Maintains standards for development of reporting documentation.
Performs other duties as assigned
Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents
Qualifications
Required:
Bachelors Degree and/or years of relevant work experience and background to equate to the degree
Seven (7)+ years of experience working in a Managed Health Plan setting
Seven (7)+ years of related business analysis/data analysis experience
Three (3)+ years of experience modeling business processes
Three (3)+ years of experience working with SQL or Cognos Reporting
Three (3)+ years reviewing SQL or Cognos code and stored procedures
Strong proficiency in data analytics and data mining tools
Strong analytical skills, knowledge of health plan operations including medical management, enrollment, claims, EDI transaction processing, knowledge of Medicare and Medicaid plans, financial reconciliation and IT/ Data systems knowledge.
Experience extracting and analyzing big data sets
Root cause analysis and requirements development experience
Strong verbal and written communication skills (experience in audit participation a plus)
Proven track record of:
ability to develop strong working relationships and establish a high level of credibility across lines of business and functional organizational levels;
continuous learning and process improvement;
problem solving and conflict resolution.
Proficiency in MS Project, Excel, PowerPoint and Word, Visio, SQL
Preferred:
Must thrive in highly dynamic, fast-paced deadline driven environments
FDR Oversight:
Business Lead Level:
In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company
Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
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