Operational Business Analyst

Hennepin Health (HH) is seeking an Operational Business Analyst to join their Claim Requirement and Audit team to work within a Health Plan. This team is accountable for researching complex claim related issues, developing claim requirements, executing text plans, and auditing claims. This includes working with account management to manage and support ongoing change requests for benefit renewals, policy changes, system upgrades, Department of Human Services (DHS), and regulatory changes.

Current Hennepin County employees who refer a candidate hired into an open competitive position may be eligible for a $500 referral bonus. For more information visit employee referral program.

Location and hours:
This position is hybrid, but primarily remote, and will be performed both on-site at the Hennepin County Health Services Building at 525 Portland Avenue South, Minneapolis, MN 55415, and remote as job duties require. Work hours will be Monday through Friday, 8 a.m. to 4:30 p.m. with some flexibility. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin.  
 
About the position type:
This is a full-time, benefit-earning position.
This position is internally classified as an Administrative Assistant, Senior.
Click here to view the job classification specification.

In this position, you will:

• Conduct research and root cause analysis on various claims to identify and resolve problem payment and configuration concerns.
• Review, research, and respond to the claim related routes received from the delegated claims vendor and other internal HH departments.
• Solicit and document claim related business requirements for new benefit, DHS, and regulatory changes.
• Audit and test complex benefit claim payments to prevent incorrect payments and ensure compliance.
• Develop test cases and complete business user acceptance testing.
• Facilitate communication between the delegated vendor and internal business departments to follow up and close action items.
• Collaborate with the delegated vendor to develop interim claim processing workarounds.
• Monitor claims related to manual workarounds; retire workarounds when solutions are implemented.
• Support claims related audit functions such as research claims outcomes, validate claims processed according to HH product business rules and DHS regulatory requirements and work closely with account management, internal audit, and across HH to document audit findings.

• One of the following:
  • Bachelor's degree or higher in public administration, business administration or related field and four years or more of experience in general administrative work relating to the management of departmental/organizational operations or in a specialty area appropriate to the position.
  • Eight years or more of general administrative work related to the management of departmental/organizational operations or in a specialty area appropriate to the position.

• Five or more years of business analyst or healthcare experience.
  
• Experience:
  • Working in claims processing systems and benefit configuration.
  • With health plan and healthcare operations.
  • With Medicaid.
  • Documenting business requirements, executing or supporting User Acceptance Testing (UAT), and/or validating configuration changes.
  • Working with diverse cultures and applying a health and racial equity and disparity reduction lens to work related duties.
• Ability to:
  • Build and maintain relationships with internal and external partners.
  • Prepare plans that meet project and program goals, implement plans, and evaluate results.
  • Analyze and evaluate operational effectiveness and prepare project reports.
  • Manage effective working relationships within and outside the organization.
  • Facilitate group discussions and interpret policies and regulations.
• Excellent communication and documentation skills.