Compliance Business AnalystValor Health PlanNorth Canton, OHCompany Summary:Valor Health Plan (HMO-SNP) is a Medicare Advantage Prescription Drug health plan designed specifically for Medicare beneficiaries that reside in a long-term care facility. Valor Health Plan is headquartered in North Canton and available in select Ohio CMS-approved counties.Position Summary:Knowledge of Medicare Advantage Part C and Part D requirements, audit protocols, annual reporting requirements and data validation process. Understanding of CMS regulatory guidance and how it affects health insurance at the operation level. Perform internal audits and data validation with ability to analyze and identify data trends that may place members and the organization at risk.Primary Duties and Responsibilities:Collect, analyze and document trends and metrics through effective and timely internal audits and reporting for Medicare Advantage Part C and Part D business operations. Ability to identify trends that may result in risk.Monthly/quarterly review and analysis of Medicare Advantage claims, appeals and grievances, enrollment and eligibility, call center data, encounter data, marketing and Part D service operations. Ability to clearly write up and communicate results.Ensure accuracy of data collection for annual and quarterly regulatory reporting submissions.Maintain knowledge of regulatory guideline changes and how it impacts health insurance operations and reporting processes.Other duties as assigned.Education and Qualifications:
- Bachelor's degree in Business Administration, Finance, Accounting or related field.
- Two-five years direct involvement in Medicare Advantage data collection and analytics preferred.
- Strong planning, organization, and problem-solving skills.
- Understanding of adverse trends related to the MAPD insurance industry.
- Demonstrated excellent verbal and written communications skills.
- Proficiency with Microsoft Office suite, including:
- Ability to use Word to edit text documents, understanding of track changes function, etc.
- Highly proficient with Excel utilizing formulas, functions, ranges, pivot tables, chart creation; knowledge of basic computations, calculating averages, finding maximum and minimum values; knowledge of setting up .csv and .txt files, etc.
- Ability to create presentations using PowerPoint and include data trend charts, etc.
- Daily use of Outlook - send and receive emails, schedule meeting invites, and include attachments
- Frequent use of Zoom - ability to set up meetings, join meetings, and utilize share function, etc.
- Ability to learn and become proficient with HPMS and Acumen portals.