Clinical Business Operations Analyst

Job Title: Clinical Business Operations Analyst

Exempt Status: Exempt

Division: HRA              

Reports to: Director, Clinical Business Operations

Episource, with over 1,500 employees worldwide, is a leading provider of risk adjustment services and solutions for health plans.  Our services help Medicare Advantage, Commercial/Exchange, and Medicaid managed care plans improve and support accurate reimbursement in a post-Affordable Care Act market. Our services include retrospective chart reviews, medical record retrieval, HEDIS/ACO quality reporting, and data analytics, allowing payers and providers to dramatically reduce costs and improve quality of care.

Job Summary:

The Clinical Business Operations Analyst is responsible for the implementation and delivery of assigned client projects within the Health Risk Assessment (HRA) business.  The Clinical Business Operations Analyst works with the Clinical Business Operations Manager to lead new project implementations for HRA clients, oversee project forecasting and performance, and assist with management of third-party vendors. The Clinical Business Operations Analyst will interface with key external and internal stakeholders, including clients, account management, data operations, clinical services, outreach, and coding, to ensure successful implementation and delivery of HRA projects. The Clinical Business Operations Analyst may also contribute to ongoing operations improvement initiatives led by the Director of Clinical Business Operations.

Responsibilities:

Responsible for contributing to an upbeat, positive and productive work environment with exceptional communication skills.  Participates in the development and implementation of reporting and business processes to meet/surpass goals of HRA client projects.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

  • Collaborate with Clinical Business Operations Manager to lead implementation process for assigned HRA projects, including the gathering of client requirements and the collaboration with internal Episource teams to launch new projects in an efficient and cost-effective manner
  • Develop and monitor HRA project delivery forecasts and provider staffing targets for assigned HRA projects to meet/surpass client goals
  • Develop and monitor KPIs for all facets of HRA project performance (across outreach, coding, data operations, and clinical services) for assigned HRA projects, escalating performance issues for resolution to relevant departmental lead and to Manager & Director of HRA Operations
  • Interface with leads of all HRA-related teams (e.g., account management, outreach, coding, data operations, clinical services) on a weekly basis to ensure successful project implementation and delivery for assigned HRA projects
  • Interface with account management and client stakeholders on a weekly basis (or as needed) for assigned HRA projects to present project performance, address client requests, and ensure client expectations are met or exceeded
  • Collaborate with Manager and Director of Clinical Business Operations to manage vendor relationships for HRA business (including third parties providing lab, diagnostic, and staffing services)
  • Requires an individual to maintain the ability to work in an environment with PHI / PII data
  • May be assigned other duties
  • Must maintain compliance with all company policies and procedures

Additional Responsibilities:

  • Must be able to work under pressure and meet deadlines, while maintain a positive attitude and provide exemplary customer service to HRA clients
  • Ability to work independently and in teams to carry out assignments to completion within parameters of instructions given, prescribed routines and standard accepted practices
  • Develops and maintains strong relationships with all internal and external stakeholders

Education/ Requirements:

  • Strong time management skills and ability to prioritize workloads
  • Excellent verbal and written communication skills, including ability to effectively communication with internal and external customers
  • 2+ years of work experience in operations management, preferably within healthcare services
  • Bachelor’s degree in Finance, Business, Industrial Engineering and/or related field required
  • Proficiency with MS Office and G-suite (gmail, google sheets, etc.) required
  • Proficiency with MS Excel required; exceptional MS Excel skills strongly preferred
  • Experience with analytics-based coding languages (e.g., SQL, Python) strongly preferred
  • Knowledge of HIPAA Compliance rules and regulations a plus
  • Must be able to work independently with limited supervision
  • Must be organized and detail oriented
  • Excellent written and verbal communication skills
  • Strong interpersonal and client management skills

Physical Requirements:

  • Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting productivity standards
  • Must be able to talk, listen, speak and view (close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus) as required to:
  • Read printed material on paper and similar medium, on a PC or similar electronic devices

EEO POLICY STATEMENT:

Episource, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Episource, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training.

Episource, LLC expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Episource, LLC employees to perform their expected job duties is absolutely not tolerated.