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Business Analyst Sr, Provider Data Operations - Covered CaliforniaCalOptima Health • California, Maryland, United States
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Business Analyst Sr, Provider Data Operations - Covered California

CalOptima Health
  • US
    California, Maryland, United States
  • US
    California, Maryland, United States
Apply Now

About

Business Analyst Sr, Provider Data Operations - Covered California Job no: 494061
Work type: Full Time
Location: 505 City Parkway West
Categories: Administrative
Join Us in this Amazing Opportunity We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity We are hoping you will join us as a Business Analyst Sr, Provider Data Operations - Covered California and help shape the future of healthcare where you'll be an integral part of our Provider Data Operations team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework.
If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Business Analyst Sr will play a critical role in translating regulatory requirements and business objectives into clear reporting specifications, business rules and implementing operational workflows. You will partner closely with the Provider Data Operations (PDO) teams, Office of Compliance, Information Technology (IT), Claims Administration, Contracting and business stakeholders to ensure regulatory alignment, data accuracy and efficient delivery of reporting and system capabilities. You will apply analytical expertise to evaluate business processes, identify opportunities, ensure reporting accuracy, compliance and alignment with organizational goals.
Your Contributions To the Team
90% - Business Support
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Leads the assessment, documentation and translation of business needs into detailed functional and technical requirements for provider data configuration updates.
Ensures provider data configurations align with enterprise data governance standards and data quality expectations.
Analyzes provider data workflows, identifies gaps and proposes enhancements to improve efficiency, accuracy and compliance.
Collaborates with technical teams to design provider data rules, validations, mappings and configuration logic that support business operations and regulatory mandates.
Supports migration and transition activities related to data conversion, crosswalk development and system rollout readiness.
Provides subject matter expertise for provider data domains, including contracting, credentialing, directory, compliance and network management processes.
Supports cross functional reporting initiatives to implement reports and processes that support regulatory requests, business operations and program outcomes.
Conduces system research and testing to ensure reports produce expected results, maintains version control to ensure that all report documentation accurately reflects the current status, including changes and issues identified during testing.
Maintains core competency in Provider Data Operations programs and organization operations, including regulatory requirements and business changes.
Supports planning, evaluation and potential implementation of a new provider lifecycle management system and/or processes, including requirements gathering, system design considerations, testing and change management activities.
Maintains an updated library of regulatory and business requirements, decisions, workflows, requirements and other documents critical to the department's data functions.
Reviews ad-hoc analysis and generates reports as requested.
10% - Completes other projects and duties as assigned.
Do You Have What the Role Requires?
Bachelor's degree in business administration, management, data science or related field PLUS 3 years of experience in health care operations, provider data management, system implementation or gathering of business requirements required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position may also be qualifying.
You’ll Stand Out More If You Possess the Following:
2 years working in a business analyst or data analyst role.
SQL experience.
What the Regulatory Agencies Need You to Possess?
N/A
Your Knowledge & Abilities to Bring to this Role
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations)
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds.
Ways We Are Here For You
You’ll enjoy competitive compensation for this role.
Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947).
The final salary offered will be based on education, job‑related knowledge and experience, skills relevant to the role and internal equity among other factors.
This position is approved for Partial Telework (If the position is Telework, it is eligible in California only).
A comprehensive benefits package.
CalPERS pension program and additional retirement packages.
Additional benefits and perks including:
A generous PTO program
A quality work life balance
Various wellness programs
Tuition Reimbursement
Professional development opportunities
Career development opportunities
Flexible scheduling
And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.
Our Work Environment When located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate.
When located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud.
When located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud.
Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impact on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.
CalOptima Health Equal Opportunity Employment Statement CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
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  • California, Maryland, United States

Languages

  • English
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