ICONMA
Our Client, a Health Insurance company, is looking for a Senior Business Analyst for their Lansing, MI/ Hybrid location. Responsibilities: The ideal candidate will bring a strong foundation in risk adjustment), reviewing and translating regulatory requirements and helping the business area implement compliant and optimal solutions. Additionally, the Business Analyst will support industry level research to ensure that best practices are implemented that minimize risk, while maximizing health outcomes for the organization's members. Success in this role demands cross-functional collaboration, critical thinking, and the ability to operate in a fast-paced, high-stakes environment. This engagement directly supports our organization's ability to remain compliant, optimize RAF accuracy, and achieve sustainable reimbursement outcomes.Business Requirements Gathering: Research, interpret and understand CMS regulations and applicable laws pertaining to risk adjustment Collaborate with stakeholders to gather and document business requirements for risk adjustment programs, translating them into functional specifications for business teams.Risk Management Develop and implement risk assessment and monitoring review processes to mitigate and/or remediate risk within the risk adjustment space Track and manage corrective action plans to address identified compliance risks and deficienciesProcess Improvement: Analyze existing controls and processes against guidance to enhance and strengthen those processes and controls in alignment with current guidance and best practices. Support the documentation, implementation and tracking of controls and systems which create enhanced efficiency and effectiveness. Requirements:Data Analysis: Ability to analyze large datasets to identify trends, patterns, and anomalies related to risk adjustment and compliance. This includes: Using data analysis tools and software. Interpreting data to understand risk adjustment and compliance issues. Business Intelligence (BI) and Reporting: Experience with BI tools and reporting platforms to create dashboards and reports for monitoring risk adjustment performance and compliance. Proficiency in MS Office applicationsRisk Adjustment Program Knowledge: Understanding of relevant risk adjustment programs, such as Medicare Advantage, and their specific compliance requirements.Regulatory Compliance: Knowledge of healthcare regulations and laws, including HIPAA, and how they apply to risk adjustment data and processes.Business Process Analysis: Ability to analyze existing business processes, identify inefficiencies, and recommend improvements to enhance compliance and performance.Problem-solving: Ability to identify and assist with resolving complex compliance issues related to risk adjustment data and processes.Communication: Excellent verbal and written communication skills to effectively communicate with internal teams, external partners, and regulatory bodies.Attention to Detail: Meticulous attention to detail to ensure accuracy and compliance in data and processes.Research: Ability to review conduct research and review of regulatory guidance to interpret and implement.Project Management: Ability to manage projects related to risk adjustment initiatives and compliance projects, requiring skills like defining scope, identifying resources, and scheduling.Stakeholder Management: Ability to collaborate effectively with various stakeholders, including clinical staff, IT teams, and management.Critical Thinking and Decision-Making: Ability to analyze situations, make informed decisions, and develop solutions to complex problems.Adaptability: Ability to adapt to changes in regulations and risk adjustment programs.Preferred Skills/Experience - Optional but preferred skills/experience. Include: Prior roles in a compliance and/or regulatory departmentEducation/Certifications - Include: Bachelor's degree in healthcare administration, business, or a related field with strong quantitative and analytical coursework Compliance related certification, e.g., CHC, CCP would be a plus, not required Why Should You Apply? Health Benefits Referral Program Excellent growth and advancement opportunities As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.