It's Time For A Change
Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely70.3% in year-over-year revenue growth in 2017. Are we recognized? Definitely. We have been named one of "Becker's 150 Great Places to Work in Healthcare" in 2016 and 2017, and one of the "50 Great Places to Work" in 2017 by Washingtonian, and our CEO was number one on Glassdoor's 2015 Highest-Rated CEOs for Small and Medium Companies. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.
What You'll Be Doing:
Evolent Health is looking for a Business Analyst, Ops Reporting to be a key member of our Medicare Advantage Operations team. This individual will report to the Director of Medicare Operations and play a critical role in executing Evolent Health's mission, focused on coordinating, monitoring, trending and supporting report requirements of business operational functions within the Medicare Advantage Operations team. This position will work with both internal and external business partners to implement ongoing operational monitoring, resolve service barriers, develop solutions to improve effectiveness and identify continuous improvement initiatives to increase service levels.
Provides supervisory leadership and performs complex activities for the Medicare Operations team by contributing to the measurement of operations and performance of our health plan administrative operations, including but not limited to claims, customer services, A&G and other core key health plan operational functions.
Defines analysis methodology and provides analytic support.
Analyzes existing systems to recommend enhancements and creates new systems to reduce manual processes and maximize the business efficiencies.
Analyzes data from conceptualization through presentation and requires proficiency with analytical tools, knowledge of data analysis methodology, use of presentation software, and strong communication skills.
Identifies, evaluates, and implements new data-driven strategies and processes for the department.
Develops tools and reports that lend valuable insights that capitalize on a combination of internal and external data.
Recommends enhancements to existing systems in accordance to business needs by creating ad hoc and standard reports as well as information delivery technologies.
Prepare reports in an accurate, concise and timely fashion.
Performs data collection, analysis, reporting.
Provide guidance and support to operations personnel and leadership towards resolution of issues with an emphasis on root cause analysis and resolution of problems.
Compile, review and analyze management reports and take appropriate action
Identify and advise Medicare Operations and other operational areas of trends, problems, and issues as well as recommended course of action; ensure timely communication; participate in the development and implementation of solutions
Monitor adherence to the efficiency and service level goals including volume, processing, timeliness, accuracy and other metrics.
Prioritize issues identified by internal or external team members and/or partner representatives and monitors progress in the resolution of the issues.
Develop deep understanding of core health plan systems, tools and resources (including vendor/partner solutions), the processing capabilities and limitations as well as provide recommendations to meet plan requirements.
Create and report operational tracking metrics and dashboards for monitoring claims, provider disputes and benefits performance
Performs periodic contractual review of provider data setups and audits each completed transaction
Coordinate corrective action plans to resolve issues
Support internal plan team members with the resolution of daily issues
Work with other departments to identify and resolve problems leading to incorrect provider data and issues regarding payment of claims or directory issues
Serve on various committees and attends required meetings
Perform other duties and projects as assigned
The Experience You'll Need (Required):
Associates Degree or similar certification with either a quantitative discipline (e.g. actuarial, statistics, economics, engineering, computer science, operations research, applied math) or healthcare (health administration, public health, medicine)
1 - 3 years of experience within a health plan, managed care organization, provider operated healthcare environment or third-party administrator
1 - 3 years of experience in collecting, analyzing, and presenting data and recommendations to management
Extensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Project
Finishing Touches (Preferred):
Bachelor's degree, with either a quantitative major (e.g. actuarial, statistics, economics, engineering, computer science, operations research, applied math) or healthcare (health administration, public health, medicine)
Bachelor's degree in Computer Science, Statistics, Mathematics or related field
3 5 years of experience within a health plan, managed care organization, provider operated healthcare environment or third-party administrator
1-3 years data analysis and business intelligence experience working with BI suites such as Qlikview, SSRS, Tableau or other enterprise class tools
Prior supervisory or team lead experience
Experience with Medicare Advantage plans
Demonstrated exceptional active listening and communications skills
Experience in systems and languages related to database lifecycle management such as MS Access, SQL Server, Visual Basic, etc
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
Evolent Health, Inc.