Position Overview:
We are seeking a detail-oriented and proactive Health Plan Operations Analyst to play a pivotal role in optimizing our office and customer business operations. This role requires a strategic thinker with the authority to formulate, interpret, and implement management policies and operational practices. The successful candidate will be responsible for major assignments in the organization’s operations, provide expert consultation to management, and be actively involved in planning both long- and short-term organizational objectives. The role also involves investigating and resolving significant issues on behalf of management.

Key Responsibilities:

Strategic Operations Management:

• Policy and Practice Formulation: Develop, interpret, and implement management policies and operating practices to enhance organizational efficiency and effectiveness.

• Operational Oversight: Lead major assignments that directly impact the organization's operations, ensuring alignment with strategic objectives.

• Consultation and Expert Advice: Provide expert consultation and advice to management on operational matters, contributing to strategic planning and decision-making.

• Project Management and Build: Manage projects related to data analysis and reporting, ensuring timely delivery and alignment with organizational goals. Oversee the development and implementation of reporting tools and systems, coordinating with IT and other departments as needed.

Data and Reporting Management:

• Data Analysis: Examine health plan data to identify trends, discrepancies, and opportunities for process improvement.

• Report Creation: Design and maintain comprehensive reports and dashboards reflecting key performance indicators (KPIs), financial metrics, and operational efficiency.

• Strategic Recommendations: Deliver actionable insights and recommendations based on data analysis to support strategic and operational decisions.

Compliance and Quality Assurance:

• Regulatory Adherence: Ensure organizational compliance with regulatory requirements and internal policies through diligent monitoring and audits.

• Quality Control: Oversee quality metrics and perform audits to validate the accuracy and effectiveness of operational processes.

Operational Support:

• Network and Access Evaluation: Evaluate network additions and access improvements in coordination with all ops departments.

• Process Improvement: Assess and enhance current operational processes and workflows, collaborating with cross-functional teams to implement and track improvements.

• Initiatives and Systems: Assist with the implementation and management of new operational initiatives and systems, working closely with Legal and Compliance departments.

Stakeholder Communication and Liaison:

• Reporting: Prepare and present findings, reports, and recommendations to management and stakeholders, ensuring clarity and alignment with organizational goals.

• Cross-Departmental Liaison: Act as a liaison between operations and other departments, fostering effective communication and collaboration across the organization.

Strategic Planning and Recommendations:

• Trend Monitoring: Stay current with industry trends, best practices, and technological advancements to drive operational improvements.

• Process Enhancement: Lead initiatives to streamline processes and improve operational effectiveness, collaborating with cross-functional teams.

• Provide actionable insights and recommendations based on data analysis to support strategic decision-making.

• Contribute to the development of operational strategies and initiatives to improve performance.

Competencies, Knowledge, and Skills:

• Technical Proficiency: Advanced skills in Microsoft Office Suite, including Excel, Word, and Access, and familiarity with Google Products.

• Commercial Health Plan Experience

• Payment Systems and Coding Proficiency: healthy understanding of provider payment systems, including reimbursement methods and payment reconciliation, combined with knowledge in medical coding practices (ICD, CPT, HCPCS).

• Health Plan Expertise: Comprehensive understanding of health plan operations, provider claims and payment systems, along with medical coding practices (ICD, CPT, HCPCS).

• Analytical Acumen: Strong ability to analyze complex data, identify trends, and provide strategic insights.

• Communication Skills: Excellent written and verbal communication skills, with the ability to present complex information clearly and effectively.

• Interpersonal Skills: Strong interpersonal abilities, with a professional demeanor and skill in building and maintaining productive relationships.

• Problem-Solving: Effective problem-solving skills with a focus on resolving significant issues and implementing solutions.

• Time Management: Proven ability to prioritize tasks, manage time efficiently, and achieve goals with a sense of urgency.

• Adaptability: Flexibility to handle multiple tasks, pivot, adapt to organizational changes, and work independently or as part of a team.

• Professional Interaction: Skill in interacting effectively with all levels of management within the organization and across multiple organizational layers.

Qualifications:

• Education: Bachelor’s degree in Health Administration, Business Administration, Data Science, or a related field.

• Experience: Minimum of 2-3 years of experience in health plan operations, data analysis, or a related role. Experience with health insurance and managed care is highly preferred.

Working Conditions:

• Full-time position with standard office hours; occasional additional hours may be required.