Business Analyst-ACA Data Submission

Company: Vernus Technologies
Location: Grand Rapids
Posted on: February 22, 2021

Job Description:

Description:**100% remote position ** Job Summary Under direct supervision, the Business Analyst is responsible for preparing and ensuring accuracy of enrollment and claims data required for submission to CMS. Will be skilled at creating and running reports from multiple databases; identifying and correcting discrepancies and analyzing root causes of data errors. Candidate will possess strong analytical skills and ability to work with many departments and vendors. Will also assist with ACA RADV Audit activities. Knowledge of the HHS Risk Adjustment process is recommended. Job Responsibilities--- Prepare monthly medical and pharmacy claims and enrollment queries for submission to CMS EDGE Server--- Determine root cause of discrepancies by understanding the business logic used for the EDGE Server--- Resolve enrollment and claims discrepancy errors and work with report developer to identify logic changes required with the queries--- Review CMS Response reports for risk adjustment gaps--- Support RADV audit analysis and provide demographic and enrollment documentation and pharmacy claim documentation in the appropriate format--- Support of ACA risk adjustment tasks related to system integration--- Other duties as assigned Qualifications--- Bachelor's degree in business or health care field--- 3 years of experience working with Health Plan enrollment or claims transactions--- Knowledge of the Affordable Care Act Individual Health Plan regulations--- Experience with CMS guidelines for data submission--- Experienced with Microsoft Excel and Microsoft Access analysis and functions--- Knowledge of HHS Risk Adjustment process--- Ability to collaborate effectively and work as part of a team and independently--- Strong Analytical and Problem-Solving abilities--- Strong attention to detail--- Skilled at written and oral communications - provided by Dice

Keywords: Vernus Technologies, Grand Rapids , Business Analyst-ACA Data Submission, Professions , Grand Rapids, Michigan