Business Information Consultant (CA Medicaid) PS32076

Anthem, Inc in Placentia, CA

  • Type: Full Time
position filled
Business Information Consultant (CA Medicaid) PS32076 **Location:** **United States** **Requisition #:** PS32076 **Post Date:** Jan 06, 2020 Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. **Business Information Consultant** **(CA Medicaid) PS32076** **Location: Work at Home or any Anthem location** Responsible for serving as an expert in encounter and claim data analysis, reporting and formulating recommendations and providing guidance to other data analysts as well as leadership and our external provider community including Management Service Organizations, Participating Medical Groups and Hospitals. **Primary duties may include, but are not limited to:** · Creates and maintains databases to track business performance. · Analyzes data and summarizes performance using summary statistical procedures. · Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies. · Creates and publishes periodic reports, as well as any necessary ad hoc reports. May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools. May make recommendations based upon data analysis. · Provides analytic consultation to other business areas, leadership or external customers. · Data analysis and reporting encompasses a much higher level of complexity. + Oversight of 60+ Participating Medical Groups (PMG), Management Service Organizations (MSO), and Hospital encounter performance.Performance includes both timeliness and completeness of encounter submissions. + Delivers monthly data to above mentioned organizations (in collaboration with Provider Services Organization) + Identifies poor performing trends and documents action plans for each poor performing entity + Reports into the Ops Excellence Council (and Senior Leadership Team) each month related to encounter performance + Works with PSO to issue corrective action plans and monitors performance of poor performers in order to escalate + Monitors monthly EDI reject reports and works directly with the technical experts at each provider organization to resolve known issues + Serves as the single point of technical contact for the groups to interact with + Collaborate with Quality on poor performing HEDIS groups + Work directly with our multiple clearinghouses on strategies to improve completeness and timeliness of encounter data + Work directly with Availity on known technical issues/barriers + Represents Anthem on industry wide encounter workgroups **Qualifications:** + Requires a BS/BA degree in related field; minimum of 5 years' experience; or any combination of education and experience, which would provide an equivalent background. + Experience with relational databases and knowledge of query tools and statistical software is required. + EDI Knowledge of HIPAA 837 transaction + Encounter transaction knowledge + Tableau experience will be a plus + Experience with Medicaid + Ability to manipulate large sets of data. Strong analytical, organizational, presentation, and problem solving skills. + This job is more focused on higher level technical expertise, mentoring staff in lower job levels, more customer facing, higher level of collaboration, work is higher volume and/or higher risk, and modeling as compared to the Bus Info Analyst Sr job. _Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc. magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at Careers.antheminc.com_ _An Equal Opportunity Employer/Disability/Veteran_ </script>

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