Business Operations Analyst, Medicare Advantage - Strategic Operations, Southwestern Health Resources (SWHR)

Qualifications

Education

• Bachelor's Degree Business or similar industry Required

Experience

• 3 Years Healthcare or Insurance Required and
• 3 Years Process Performance Improvement to include 2 years' experience with key metrics and analytics Preferred

Skills

• Strong policy, process, procedure management
• Ability to coordinate resources for end to end process assessments and identify areas of opportunities.
• Strong oral and written communication skills, including presentation skills (MS Visio, MS PowerPoint, Word).
• Strong problem solving and troubleshooting skills with the ability to exercise mature judgment.
• Ability to work independently and manage multiple task assignments.
• Ability to collaborate with internal functional managers and payor partners on process improvement activities
• Understanding of key reporting metrics, analytics, financial terms. Strong in MS Excel.

Position Responsibilities SWHR Business Operations Analyst is

Perform monthly business analysis:

• Identify opportunities for process improvement within the Medicare Advantage book of business.
• Monthly analysis of MA performance reporting, which includes information relating to financial, RAF, Quality, Utilization Management, Case Management, as well as trending analysis.
• Partner with key stakeholders to implement recommended changes based on outcomes of monthly analysis

Drive policies, procedures and operational best practices outlined in the MA Playbook:

• Process optimization and improvement to include-
• Utilize reporting/analytics to identify opportunities for performance improvement against operating metrics.
• Partner with operational key stakeholders for process improvement implementation.

Lead the monthly CAP/Eligibility Claims Reconciliation Review Process:

• Review Capitation payment for discrepancies in eligibility of CAP.
• Report inconsistencies to payor for resolution.
• Attend operational MA monthly operations meetings; action planning, tracking and follow up on issues to resolution.

Issue resolutions between operational departments and payor partners, and any other tasks identified by the Program Director.

Why Southwestern Health Resources 
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other.  To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.

We invite you to learn more about us at www.southwesternhealth.org.

Let’s move healthcare forward – together.

Highlights:

• Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
• SWHR is the parent organization of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.

Additional perks of being a SWHR employee:

• Gain a sense of accomplishment by contributing in a teamwork environment
• Positively impact patients’ quality of life
• Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
• Enjoy opportunities for growth

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org.