Analyst

• Assist with the day-to-day conflict check operations, including processing daily conflict checks
• Ensure compliance with established procedures, and maintaining data integrity
• Assume increasing responsibility over time for the training of new team members
• Ensure high standards for customer service are met
• Perform conflict of interest/business relationship analyses via a conflicts analytics tool
• Assist with other Conflict Management initiatives and duties as requested

Conflict Analyst

• Support critical clinical applications that directly improve patient care and nursing workflows across Banner Health's network.
• Work with systems including Cerner applications, Bridge Medical, and others.
• Collaborate with diverse teams to implement and optimize health information systems.
• Participate in on-call rotation and additional hours during implementations.
• Provide knowledge, guidance, and research to define and modify specifications and processes of complex information systems.
• Ensure timely updates and communication to the customer.
• Develop technical documents and testing scenarios, coordinate change management documentation.

IT Clinical Solution Analyst II

• Manage the day-to-day conflict check operations, including processing daily conflict checks, overseeing the conflict queue and attending to all checks in progress to ensure timely and accurate processing, ensuring compliance with established procedures, and maintaining data integrity.
• Assume increasing responsibility over time for the training and management of new and existing team members, aiming to assume direct supervisory duties as the team grows.
• Ensure high standards for customer service are met, including 24-hour turn-around for initial conflict checks and coverage for after-hours/urgent responses.
• Ensure high level of quality control is maintained, including data accuracy and integrity in the conflict system, sufficient intake documentation is stored, and routine evaluation of conflict checks in process to close outdated leads.
• Perform conflict of interest/business relationship analyses via a conflicts analytics tool, using firm policies and procedures as guidance in issue identification and ensuring sufficient information is gathered to perform a thorough analysis, which may involve discussions with senior staff and independent research through external sources, including Pacer and other sources as needed.
• Act as the primary contact for the new client intake software, including provision of training to field staff on use of the software and dashboard management.
• Assist with other Conflict Management initiatives and duties as requested.

• Completes scheduled and urgent benefit additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
• Acquires and maintains a basic level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations.
• Complies with standards set forth regarding benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards.
• Performs quality assurance peer reviews and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
• Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to general customer questions and issue resolution requests.
• Supports internal customers by participating in client meetings, audits and new program implementations with other areas of the company, answering benefit setup questions and providing guidance to other areas and roles on the benefit configuration process.
• Adapts to industry changes and evolving technology, maintaining a basic level of understanding of both legacy and emerging products and systems.
• Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
• Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies.
• Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards.
• Contributes to training and maintains a mentoring relationship with new and existing benefit configuration team members.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.

Benefit Configuration Analyst

• Provide IT Clinical Application customer support expertise for EHR and related clinical applications
• Answer, log and resolve customer issues and provides supplemental training via a centralized, remote call center structure
• Collaborate closely with other IT Clinical Application, Education, and IT teams to identify, investigate, track, and resolve project, system or application issues ensuring the solution is timely and of acceptable quality
• Maintain up-to-date knowledge of trends and advances in the field of Healthcare IT, as well as new developments in computer hardware and software technology
• Perform Advocate functions to ensure technology solutions support patient care standards and outcomes
• Utilize existing technology in a manner which promotes maintenance of patient safety and confidentiality.

Clinical Service Desk Analyst I

• Configure and customize financial systems such as ERP/General Ledger, Financial Reporting, Travel, and Reimbursement, to align with business and regulatory requirements, processes, and changes. Develop and maintain custom fields, forms, workflows, and records to enhance system functionality.
• Act as a subject matter expert to departments and leaders across ActBlue on the configuration, customization, data, and reporting functionality within our ERP system.
• Provide ERP support to users within the organization by troubleshooting issues, resolving problems, and offering guidance on system usage. Conduct training sessions for new and existing users to ensure optimal utilization of NetSuite features.
• Continually build out automation of manual processes, as well as NetSuite General Ledger and NetSuite Planning and Budgeting (NSPB) reporting.
• Support new integrations and system implementations related to ERP.
• Monitor interfaces with the payment processing (Stripe), travel platform (Navan), payroll system (Rippling), expense management (Expensify), corporate cards (American Express), corporate transportation (UBER/Lyft) and Amalgamated Bank. Ensure the integrity of interfaces and troubleshoot to resolve any issues.
• Ensure all updates and transitions to new releases are implemented without interruption to the production environment.
• Communicate effectively with internal and external stakeholders to provide updates, gather feedback, and address concerns.
• Support supplementary projects as assigned, ensuring timely and efficient completion in line with organizational objectives and standards.

Senior ERP Analyst, NetSuite

• Completes scheduled and urgent benefit additions, terminations, and changes timely and accurately to prevent member access to care issues, missed performance guarantees and potential liquidated damages.
• Acquires and maintains a basic level of knowledge and interpretation of multiple adjudication system screens and functions on a field-by-field level to design both standard and custom configurations to meet client expectations.
• Complies with standards set forth regarding benefit design and configuration including HIPAA, NCPDP and Navitus internal business standards.
• Performs quality assurance peer reviews and uses sound business judgment and expertise to contribute toward the creation of root cause analysis of issues.
• Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to general customer questions and issue resolution requests.
• Supports internal customers by participating in client meetings, audits and new program implementations with other areas of the company, answering benefit setup questions and providing guidance to other areas and roles on the benefit configuration process.
• Adapts to industry changes and evolving technology, maintaining a basic level of understanding of both legacy and emerging products and systems.
• Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.
• Contributes to the creation and ongoing maintenance of departmental training materials, work instructions and policies.
• Conducts system enhancement and regression testing of a low to moderate level of complexity for benefit configuration processes to ensure compliance with state, federal and client regulations/standards.
• Contributes to training and maintains a mentoring relationship with new and existing benefit configuration team members.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

Analyst, Benefit Configuration

• Analyze, research, resolve and respond to confidential/sensitive appeals, coding disputes, grievances and coverage/organization determinations.
• Analyze, interpret, and explain health plan benefits, policies, procedures, medical terminology, coding to members and/or providers.
• Regularly and independently exercise judgement to make appropriate decisions based on BlueCross NC policies and guidelines.
• Acts decisively to ensure business continuity and with awareness of all possible implications and impact.
• Prepare files and develops BlueCross NC position statements for external reviews performed by independent review organizations, benefit panels and external medical consultants.
• Provide comprehensive appeals, coding disputes and grievances responses that support the decision and comply with regulatory and accreditation guidelines.
• Document extensive investigation, relative findings, and actions in all applicable systems.
• Accountable for monitoring daily reports to ensure service timeliness and compliance is met.
• Gather clinical information by using established criteria provided in corporate medical policies; partner with Medical Directors who are responsible for all decisions regarding clinical appeals/grievances.
• Ensures timeliness, quality, and efficiency in all work to comply with applicable mandated State and/or Federal accreditation agency standards.

Appeals Analyst

• Conducts investigations in accordance with investigative action plan and documents all findings in standard with SIU Policies and Procedures
• Identifies errors and control deficiencies.
• May be required to provide deposition and/or testimony
• Conduct interviews of victims, subjects and/or other related persons
• Prepares and conducts presentations and/or provides content for health care fraud and abuse education and awareness.

Senior Fraud Investigations Analyst

• Review and analyze criminal records to assess applicant eligibility and mitigate risks for clients
• Develop expert knowledge of screening software and maintain compliance with Fair Credit Reporting Act (FCRA) regulations
• Manage and respond to inquiries from clients and consumers via phone and email
• Provide guidance to clients and consumers on the next steps in the screening process
• Deliver accurate and timely updates on open tasks to relevant stakeholders
• Assist peers and co-workers with workload management and problem resolution
• Participate in ongoing training sessions and team meetings

Analyst jobs in Wyoming

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Conflict Analyst

IT Clinical Solution Analyst II

Conflict Analyst

Benefit Configuration Analyst

Clinical Service Desk Analyst I

Senior ERP Analyst, NetSuite

Analyst, Benefit Configuration

Appeals Analyst

Senior Fraud Investigations Analyst

Background Verification Analyst