The role of the Expert Analyst on the Medicare Advantage Submissions team is to help maximize risk scores and revenue associated with the submission of Risk Adjustment Processing System (RAPS) and Encounter Data Processing System (EDPS) data to CMS for all full service Medicare Advantage business process owner (BPO) clients. The Expert Analyst will work with team members to research, analyze and manage system generated edits and CMS assigned errors so data can be processed to a successful CMS acceptance status. Tasks also include reconciling all RAPS & EDPS submitted claims and supplemental records for all open payment years for all BPO clients.
Provides RAPS & EDPS error resolution for BPO clients through team collaboration and working with business partners.
Researches, analyzes, identifies, and evaluates data from system errors to evaluate existing and potential trends and issues.
Communicates results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.
Possesses and maintains a comprehensive understanding and knowledge of business, products, corporate organizational structure (including functional responsibilities), and research principles/methodologies.
Assists in ensuring RAPS & EDPS compliance with CMS regulations.
Collaborates with Subject Matter Experts to develop accurate documents.Ensures complete, accurate and timely data for reporting purposes.
Recommends and implements solutions to identified problems/root cause of issues.
Provides expertise and guidance to unit and corporate staff as required.
Represents and participates in group or committee discussions.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics or a related field. Master's degree preferred. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
Five (5) years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Strong communication skills are required to understand, interpret, and communicate ideas.
Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
Strong analytical, organizational, planning, and problem solving skills.
Ability to effectively interface with employees at all levels.
Other related skills and/or abilities may be required to perform this job.
Experience executing in a fast-paced environment with tight deadlines.
Administer and adhere to corporate and departmental policies, practices and procedures.
Work is performed in an office setting with no unusual hazards.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.