HMSA

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Senior Solutions Analyst (Utilization Management)

at HMSA

Posted: 10/2/2019
Job Reference #: 5000464191106
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Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

Lead and/or coordinate activities to support HMSA's Utilization Management (UM) program through implementation of comprehensive systems and/or solutions to support operational activities and ability to conduct complex data analysis requested by management and medical directors. Provides expert level knowledge on various enterprise projects to represent Medical Management (MM) and UM programs.

Minimum Qualifications

  1. Bachelor's degree and three years of related work experience; or equivalent combination of education and related work experience.
  2. Proficient working knowledge of Microsoft Office applications.
  3. Effective verbal and written communication skills
  4. Strong organization and time management skills
  5. Strong Project Management Skills
  6. Strong business knowledge and experience
  7. Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy
  8. Adept at queries, report writing and presenting findings
  9. Knowledge of statistics and experience using statistical packages for analyzing large datasets.

Duties and Responsibilities

  1. Lead and/or coordinate implementation efforts by MM for corporate system applications / solutions to support MM (or corporate) related activities.
    • Organizes plans, implement and track activities.
    • Consistently communicates frequently and effectively to all team members, stakeholders and leadership through reports and/or presentation.
  2. Support MM's business solution requirements for the department through data reporting from various HMSA system applications and complex analytics utilizing established techniques or tools.
    • Respond to data requests of moderate to high complexity for the development and evaluation of medical policy and utilization management activities.
    • Solicit, document and/or clarify with business the reporting requirements and scope to include but not limited to what question is the business trying to answer, intent of the detailed data, anticipated audience and summary requirements.
    • Develops, implements and analyses statistical models and processes to systematically monitor claims activity for unusual patterns of requirements; including participation in relevant internal calls and/or meetings, researching and reading reporting guideline documentation.
    • Maintain requisite knowledge of the current regulatory reporting requirements; including participation in relevant internal calls and/or meetings, researching and reading reporting guideline documentation.
    • Maintain requisite knowledge of current workflows for primary reporting requirements; including participation in meetings with the business and/or user groups.
    • Maintain requisite knowledge of reporting software / application used to support ALL reporting requirements.
  3. Train, mentor and coach other Business System Analysts to understand HMSA's business practices, business tools, core business systems and development of corporate documentation for business requirements, IS or business solutions and testing.
  4. Support MM staff by resolving complex or elevated problems associated with any system application or system enhancements implemented to support MM related activities.
  5. Lead and/or coordinate projects for the department under the direction of the MM Senior Management team which includes the Vice President, Director, Senior Manager or other management designated by Senior Management team.
    • Consistently communicates frequently and effectively to all team members, stakeholders and relevant parties, and escalates as appropriate.
    • Effectively facilities and manages project team meetings, competing needs, project changes and issues.
    • Maintain requisite knowledge of the specific activity; including participation in relevant internal calls and/or meetings, researching and reading updated material / documentation and/or soliciting information of respective business owners.
  6. Represent the department on corporate or cross-functional workgroups as a subject matter expert.
  7. Perform other duties as assigned.