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011120 CCA-Enrollment

Position Summary:

The Enrollment, Retention, and Revenue Reconciliation Department (ERR) is responsible for ensuring enrolled members are present in the enrollment system of record. These records are then extracted from that system and sent to all appropriate downstream systems to ensure that members receive all services and benefits associated with their enrollment. ERR provides analytical and operational support to the end-to-end enrollment process. The department supports continuous improvement, including reports, operational workflows, gap and data analysis, and processes analysis.

The Sr. Analyst reports directly to the Director of Enrollment, Retention, and Revenue Reconciliation. He/She should be a self-starter and effective collaborator, showing strong interest in operations, data analysis, process improvement, strong technical/analytical and problem-solving skills, as well as good written and oral communication skills.

Supervision Exercised:

+ None

Essential Duties & Responsibilities:

Responsible for bridging the gap between IT and the business using data analytics to assess processes, determine requirements and deliver data-driven recommendations and reports to stakeholders.

Reports

+ Develops reports using tools such as Tableau, Looker, SQL server, and Excel to automate and optimize processes and to track and assess performance

+ Creates reports to support and track end-to-end enrollment from internal to external systems.

+ Partners with IT, Sales, Ancillary, Clinical, and Claims teams to support end-to-end enrollment.

Process Improvement

+ Partners with IT, Sales, Ancillary, Clinical, and Claims teams to develop and review workflows, to streamline processes and increase efficiency

+ Facilitates exploratory sessions to develop a shared understanding of a business problem, the possible solutions and next steps. Documents requirements based on the outcome of the sessions and maps it to meet CCA requirements.

+ Creates Visio diagrams or other visualizations to use in prototype review sessions

Process Monitoring

+ Monitor processes to ensure regulatory compliance, and to identify opportunities for continuous improvement

Data Analysis

+ Analyzes large sets of data, summarizes, and presents results

+ Develops and analyzes quantitative reports to assess enrollment, vendor optimization and adherence to policies and procedures related to various topics

+ Tracks, analyzes, and resolves enrollment issues

Liaison between ERR and Other Departments

+ Coordinates and liaises between ERR and other departments, when applicable, such, as CCA’s Claims Department, CCA’s Third Party Administrators, IT, and Clinical Departments

Working Conditions:

+ Standard office conditions.

Required Education:

+ Bachelor's Degree in information systems or related quantitative field required (Finance, Business, Computer Science, Mathematics, Economics, or similar)

Required Experience:

+ 2 – 4 years of relevant experience

+ 2+ years of analytical experience with data or statistical analysis in healthcare industry

+ 2+ years of experience in developing and using large relational database modeling concepts and practices (SQL Reporting, or similar)

+ 2+ years SQL Server programming experience

+ 2+ years of experience with BI products such as, Tableau, Looker

+ Health care industry experience

Required Knowledge, Skills & Abilities:

+ Advanced knowledge of Excel, including use of Pivot tables and SQL

+ Strong understanding of financial concepts and/or managed care

+ Ability to establish and maintain positive and effective work relationships with internal staff, external vendors, and state and federal agencies

+ Proven ability to translate business needs into BI requirements

+ Proven skills and judgment necessary for independent decision-making

+ Strong organizational, time-management and problem-solving skills

+ Strong math and analytical skills

+ Ability to work independently and within a team environment

+ Strong communication skills both written and verbal

+ Critical listening and thinking skills

Language(s):

+ English

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.