Regulatory Business Analyst

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Business Analyst

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Monitor and analyze existing and new regulations affecting all Peak Health lines of business • Interpret regulatory filing requirements and translate them into business requirements • Develop extracts and compile data to meet reporting requirements • Provide operational guidance and technical support for CMS report deliverables • Create standardized reports using CMS data specifications, underlying data elements, and SQL • Provide feedback on operational workflows to ensure data integrity and regulatory compliance • Interview stakeholders, research business needs, and draft, edit, and validate requirements documentation • Collaborate with stakeholders to develop and execute a repeatable, measurable, and cost-effective regulatory reporting roadmap • Support internal and external audits by compiling and researching claims, enrollment, premium, case notes, and other relevant information • Present audit findings to leadership • Communicate analytical results to business stakeholders and recommend improvements to workflows, reporting processes, and efficiencies • Support regulatory reporting strategy, objectives, and initiatives through reports and analysis • Collaborate across product, operations, medical management, provider contracting, and compliance teams • Support internal stakeholders, data owners, clients, CMS, CMS vendors, and external data auditors • Perform other duties as assigned or requested

🎯 Requirements

• Bachelor’s Degree in Health Administration, Business Administration, Mathematics, Computer Science, Statistics, Information Systems, or a related field • Five (5) years of experience monitoring, managing, manipulating, and drawing insights from data in a managed care company • Three (3) years of experience working with claims, enrollment, appeals, and grievances data for regulatory submissions • Epic Certification or Accreditation for Cogito, Caboodle Data Model, and Clarity Data Model, or ability to obtain such certification or accreditation within 60 days of hire • Three (3) years of experience in data analytics, including software, modeling, ETL processes, data warehousing, and visualizations • Strong programming skills with SQL and ability to query multiple tables and databases • Experience with Microsoft SQL Server Management Studio or SAS Enterprise Guide • Experience with Tableau or PowerBI • Strong problem-solving and quantitative abilities • Excellent communication and collaboration skills • Attention to detail • Experience with regulated government products, including ACA, Medicare, and Medicaid • Working knowledge of claims, utilization management, member, and/or provider data • Proficient computer skills, including Microsoft Office Suite and Excel functionality such as pivot tables, VLOOKUPs, and macros • Understanding of business function interdependencies within a health plan setting • Ability to work independently and in a team environment • Effective time management and organizational skills

🏖️ Benefits

• Full-time, exempt position • Primarily remote work setting • Occasional travel to office may be required