Regulatory Reporting Analyst - Smithfield, United States - Neighborhood Health Plan of RI

Neighborhood Health Plan of RI Smithfield, United States

2 weeks ago

Description

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

The Regulatory Reporting Analyst is responsible for providing the necessary analysis based on integrated healthcare data to deliver high quality solutions to meet Regulatory Reporting needs for the organization.

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 and systemic solutions to operational issues.

Analyzes sets of data into clear and concise observations; facilitate exploratory sessions to develop a shared understanding of a business problem, the possible solutions and next steps; as well as document requirements based on the outcome of the sessions.

The Analyst reviews certain regulatory memoranda, issue notifications, disclosures and work with the Manager of Regulatory Reporting to develop appropriate action.

Duties and Responsibilities

Responsibilities include, but are not limited to the following:

Determines impact of business process and system changes to development of reporting

Monitors and tracks changes to reporting requirements from regulatory agencies

Serves on governance committee to evaluate proposed business process and system changes as needed

Acts as a primary consultation resource for analysts and developers within the team

Coordinates and contributes to development of business requirements, functional requirements, process flows, reference materials, user guides and code release artifacts as appropriate

Conducts quality assurance validations and integrity of data collected, analysis performed, and reports generated

Facilitates reporting process and development and/ or enhancement of procedure for the audit process

Maintains standards for development of reporting documentation

Maintain accurate CMS Audit Protocol universe requirements

Maintains accurate State and federal reporting requirements

Supports Manager of Regulatory Reporting in the development of Regulatory Reporting team roadmaps

Serve as a liaison between data analysts and business departments to translate business functions needing into data requirements for reports and dashboards

Proactively clarify scope and requirements to provide accurate status of projects and timely delivery of reports

Help develop data dictionaries, as needed to identify how data is being used and interpreted

Develop relevant metrics and alerts for prospective data issues

Ensure consistency/standards across all reports, dashboards, and tools through extensive quality control and review process

Ensure appropriate data gathering, reports, and analysis are in place to meet certain CMS and State requirements

Track, analyze and resolve data inaccuracies and/or negative data trends (duplicates, incomplete information, inconsistencies, etc ) and engage appropriate stakeholders

Record, respond, and help resolve data issues in a proactive manner

Embodies willingness to learn the technical aspects of reporting

Performs other duties as assigned

Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood's 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:
Bachelor's Degree or equivalent education and/or years of relevant work experience and background to equate to the degree

Three (3)+ years of experience working in a Managed Health Plan setting

Three (3)+ years of related business analysis/data analysis experience

Three (3)+ years of experience modeling business processes

Strong proficiency in data validation and quality assurance

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

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:
Thrive in highly dynamic, fast-paced deadline driven environments

Three (3)+ years of experience working with SQL or Cognos Reporting

Three (3)+ years reviewing SQL or Cognos code and stored procedures

Familiarity with version control systems related to documentation and software

Understanding of the System Development Life Cycle (SDLC) in software development

Basic understanding of Relational Database Management Systems (RDBMS), i e , Microsoft SQL Server or Oracle Database

Proficiency with Excel formulas, i e, IF, VLOOKUP, INDEX-MATCH, COUNTIF, SUMIF, etc.

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