UPMC Health Plan is seeking a Medical Assistance Operations Analyst in the Medicaid Department. This is a full time position working Monday through Friday daylight hours located in the US Steel Tower. This will be an in office position with flexibility to work from home after initial training.
The MA Operations & Data Base Analyst will support the Medical Assistance Department’s operational related activities to meet or exceed the expectations of the Department of Human Services (DHS). .The position will serve as the primary point of contact for the day-to-day management of operational issues responding to urgent and time-sensitive issues and requests.
This team is an operational group within the Medicaid Department. They interface with basically every department. The role would involve working among a group of other analysts.
- Conduct primary and secondary research to prepare accurate and timely responses to internal/external and DHS requests for information including member and provider complaints or other miscellaneous topics. Monitor due dates and perform needed follow-up with task owners.
- Aid in the preparation of research responses, periodic reports, and member/provider communications for required submission of final versions that are well-coordinated and meet time-sensitive agency deadlines.
- Perform project and data analysis as needed by Management.
- Identify trends and process improvement opportunities.
- Recommend and implement process improvement initiatives within the department as well as implementing process improvement initiatives based on management decision.
- Participate in improvement sessions with various delegates of other functional departments to continually enhance the quality and timeliness of Health Plan operational activities related to the daily operations of the Medicaid product.
- Implement various operational elements and procedures that resulted from DHS inquiries.
- Participate in the development, review/edit and distribution of Health Plan member and provider materials while following established protocol for seeking DHS prior approval as required. Process and follow-up all on requests for DHS approval, i.e., community events, marketing requests, annual work plans, communications, etc.
- Work with the Medical Assistance Administration, and other various Health Plan departments such as but not limited to, Finance, Community Outreach and Operations departments to carry out tactical directives that resulted from strategic product development meetings related to the Medical Assistance program.
- Work with other subject matter experts to support product service area expansion efforts, their workflow updates, or other policy/regulatory changes, as necessary.
- Work with other department leaders to ensure service area expansions, benefit changes or other regulatory changes are well-coordinated and meet time-sensitive agency deadlines.
- Represent the Medicaid Operations Team while attending multi-departmental meetings.
Act as a back-up to the Medicaid Correspondence Mailbox Team, as necessary.
- Bachelor’s Degree preferred
- Minimum of 3 years of demonstrated experience/knowledge of Managed Care (Health Insurance) required
- Experience with Medicaid managed care is preferred.
- Excellent organizational capabilities with ability to work effectively as a team player.
- Ability to continuously interact effectively and professionally with all levels of UPMC Health Plan and DHS staff is required as well as forge strong interpersonal relationships within DHS, other Health Plan departments, and external audiences
- Excellent written and oral communication skills.
- Background in areas such as: Communication, Data entry, Compliance, Administrative is preferred
- Attention to detail is required
- Willingness and ability to learn new operational procedures and information within short-time frames is required.
- Ability to handle multiple priorities/projects in a fast-paced professional environment is required.
- Excellent planning, communication, documentation organizational, analytical, and problem solving abilities required.
- Strong computer skills with a working knowledge of project management, word-processing and database software, i.e. Access, Share Point, Excel, Word etc required.
Demonstrated performance in meeting deadlines required.
Licensure, Certifications, And Clearances
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