- 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.
- 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
- 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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Regulatory Reporting Analyst - Smithfield, United States - Neighborhood Health Plan of RI
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 / ExperiencedDescription
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:
Qualifications
Required:
Preferred:
