Senior Business Analyst (OhioRISE)

Job DescriptionAs part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, Ohio RISE will help children and their families who are experiencing barriers achieve positive health outcomes and high quality of life indicators by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.This is a full-time teleworker position in Ohio. The Senior Business Analyst creates and executes specific deliverables related to provider data and activities as part of a team assigned to a business-sponsored project. Key contributor to overall project successFundamental Components: Maintain and update provider data applications and coordinate the data verification process for providers enrolled in networks Oversee and coordinate operational and administrative activities associated with provider relations, including provider education and liaison responsibilities, marketing and promotion, and facilitation of credentialing and certification Manage and resolve complex provider data issues, such as mass change updates, roster management, limited reconciliations and direct submissions of urgent requests Coordinate provider data between the health plan database and various external vendors and internal business systems Participate in the reconciliation and provider data projects Oversee the provider termination process including adding and changing new or existing provider records in the medical information system Design and generate reports to monitor department activity, current panel providers and State compliance Consistently performs analysis and translates business needs to create high-quality Business Requirements and Functional Specifications documentation within specified time frames to solve most complex problems (multiple interfaces with other systems across multiple business units) considering all impacted components from an end-to-end perspective. Ensures end-to-end traceability of requirements is complete. Expert in one or more business systems. Applies specific functional and/or business expertise to perform assigned tasks and develop specific project deliverables. Documents, tracks, and resolves issues related to data quality. Contributes to the design and mapping of data conversion strategies. Completes project activities on time and within budget, and proactively identifies and communicates issues that may jeopardize milestones or project budget to the Project Manager. Creates appropriate communication materials are documented and distributed appropriately. Guides and advises less-experienced Business Analysts.Required Qualifications 5+ years provider data experience including data reconciliation and provider data cycle. Ability to recognize complex problems vs. objectives and apply creativity to analyze situations, develop solutions and procedures.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Project management experience preferred.Education Bachelor's degree in a Business or HealthCare field, or an equivalent combination of education and work experience in a related field.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19