Research Analyst

Department:                 Business IT & Claims Administration

 

 

 

Reports To:                  Business Analyst Manager

 

 

 

Status:                         Full Time, Exempt

 

 

 

Hours:                          Monday – Friday

 

 

 

Supervision:                This position does not supervise any other staff

 

 

 

Date Updated:              October 2022

 

 

 

Summary:                    This position provides research to acquire, document, and assist with the interpretation of regulatory requirements; tests and validates systems configuration; performs financial impact analyses; identifies claims for adjustment; and researches all internal and external requests applicable to operations at PrimeWest Health.

 

                       

 

Reporting Accountability – N/A

 

Role and Key Responsibilities
Assist the Business Analyst Manager and PrimeWest Health staff in the following as needed:

1. Research written and electronic documentation from Federal governing bodies including the Centers for Medicare & Medicaid Services (CMS) and State governing bodies including the Minnesota Department of Human Services (DHS) for issues applicable to claims operations at PrimeWest Health
2. Research internal written and electronic documentation as needed to clarify issues and to determine applicability to operations at PrimeWest Health
3. Create and update issues as needed in the issues logging database
4. Monitor and assign logged issues appropriately to ensure timely follow-up
5. Assist with the creation and editing of Business Requirements Documents (BRDs) as they pertain to operational processing enhancements, Electronic Data Interchange (EDI) edits, and automation opportunities for all lines of business
6. Perform testing and validation of manual or programmed system enhancements as needed
7. Perform financial and utilization analysis to determine accuracy of configuration or claims processing or to assess areas for prioritization of programming
8. Represent the Business Analyst team in various workgroups to identify and clarify requirements as needed
9. Facilitate internal workgroups as needed
10. Ensure clear and concise oral and written communications in order to minimize misinterpretations
11. Provide claims processing staff with input for the development of training and training materials as needed
12. Participate in the gathering and documentation of information for various audits, including Healthcare Effectiveness Data and Information Set (HEDIS^®) audits, financial audits, System and Organization Controls (SOC) audits, and CMS audits
13. Participate in claims or claims adjunct systems’ product reviews and provide input with regard to functionality and applicability
14. Provide research as needed to develop new policies and assist with ensuring the accuracy of regulatory citations in existing policies

 

 

General PrimeWest Health Responsibilities

1. Abide by the PrimeWest Health Code of Conduct Comply with all PrimeWest Health policies and procedures Comply with the Health Insurance Portability and Accountability Act (HIPAA) and all other privacy laws Be familiar with building safety procedures and alert maintenance if something requires attention Keep public areas of the department and office neat and clean Conduct other responsibilities and activities as needed and assigned

 

 

Professional Competencies

1. Knowledge and comprehensive business understanding of common health care claim data sets and their applicability to the claims process, including paper and electronic claim form equivalents Familiarity with applicable Medicare, Medicaid, and commercial reimbursement methodologies. Familiarity with Minnesota Medical Assistance (Medicaid) reimbursement methodologies preferred, but not required. Ability to efficiently navigate general health care websites Ability to be flexible and prioritize work Detail-oriented and self-motivated

 

 

Educational Requirements and Required Qualifications

1. At minimum, two years of post-high school education in business or a field of study related to health care and/or claims administration; may substitute experience in health care billing or claims payment administration on a year-for-year basis. Two or more years of experience in health care claims or a claims-related position with a health care claims payer organization or provider billing environment beyond the education or experience requirements preferred. Demonstrated knowledge of, and proficiency in, Word, Excel, Visio, and Outlook required. Flexibility and ability to handle multiple tasks. Demonstrated organizational skills and attention to detail. Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills. Ability to adapt to varied situations requiring constructive thinking, analysis, interpretation, and evaluation. Ability to practice judgment and problem solve in a calm, logical, technical, timely, and accurate manner. Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 20 pounds. Some travel, including overnight travel, may be required.

 

 

Appropriate Licensure and Certification Requirements – N/A  

 

Collaborative Efforts with Other Departments

1. Administrative Services Care & Population Health Management Corporate Compliance & Auditing Information Systems & Technology Member & Provider Services Operations Pharmacy Management Quality & Utilization Management

 

 

Supervision – N/A  

 

This position description is not to be construed as an exhaustive statement of essential functions or responsibilities.

 

 

 

Location: Alexandria, Minnesota – This position offers the possibility for remote/hybrid work

 

 

 

PrimeWest Health will accept résumés for this position until filled. No phone inquiries please. Employment to begin as soon as possible.

 

 

 

Qualified candidates should submit their résumé and cover letter to:

 

 

 

Jeramie Harris at jeramie.harris@primewest.org

 

Please put “Research Analyst” in the subject line.

 

 

 

Or

 

 

 

Attn: Jeramie Harris

 

Director of Business IT & Claims Administration

 

PrimeWest Health

 

3905 Dakota St

 

Alexandria, MN 56308

 

PrimeWest Health is an Equal Opportunity Employer Committed to Diversity, Equity, and Inclusion