Employment Spot

Job Description

The Business Analyst, Medicare Part D Enrollment and Billing is responsible for the planning and analysis of complex business procedures pertaining to the Medicare Part D Enrollment and Billing workflows by performing the following duties.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Analyze and report weekly reconciliation data from the following internal/external reports;
  • The Medicare Membership System feed as compared to the Medicare Membership Accretion file.
  • The Medicare Membership Accretion file as compared to the Batch Completion Report.
• Troubleshoot systems related issues regarding the functioning of core Part D Operations systems.
• Analyzes enrollment and billing workflows and procedures in order to assist in the development of new or modified systems.
• Consults with business unit management and staff to identify and document business needs and objectives.
• Consults with business unit management and staff to identify and document current operational procedures.
• Consults with business unit management and staff to obtain additional data and evaluate alternatives applicable to system development activities.
• Provides technical assistance in identifying, evaluating, and developing systems and procedures.
• Tracks and documents changes to functional and business specifications.
• Creates or assists others in the writing of user documentation, instructions, and procedures.
• Leads or assists in the creation and execution of acceptance test plans.
• Monitors and documents post-implementation problems and revision requests.

Job Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Proficiency in the rules and regulations affecting Medicare lines of business, specifically as they apply to the following areas of Part D:
  • Enrollment system workflow
  • Billing system reconciliation workflow
• Extensive knowledge and understanding of CMS reports, specifically the application of the following:
  • The Monthly Membership Report
  • The Transaction Reply Report
  • The Direct Subsidy Report
  • The Batch Completion Report
• Ability to understand and analyze data.
• Expert working knowledge of FACETS software.
• Proficiency in the use of primary analysis tools including Microsoft Access and Excel.
• Intermediate proficiency in the use of SQL.
• Ability to develop and manage key internal relationships.
• Other duties as assigned
• Must be willing to travel

EDUCATION and/or EXPERIENCE

• Bachelor’s Degree or equivalent work experience required.
• A minimum of 3 years experience as a business analyst in a related field or environment.