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Business Consultant Specialist National Payment Integrity Reporting Rancho Cucamonga, CA


The Business Consultant/Specialist is responsible for providing insight and guidance through Reporting/Analytics for COB/OCI, Code Editing and Recovery within the National Payment Integrity (NPI) Department. This includes engagements with various internal functional leads and external parties such as Claims Operation, KPIT, Membership and other Regional and National teams. This role will leverage standard principles, techniques and tools too asses clients- business needs and identify areas of opportunities such as the identification of key performance drivers and inhibitors , systems and process improvements that will help increase overall NPI savings and efficiency. This role will utilize various systems and data sources to deliver monthly reporting and narrative around each functional area and support for NPI initiatives. This role accountabilities will include but are not limited to the following:

- Assisting with the delivery of Monthly Claims Admin Dashboard

- Researching and report data discrepancies and insuring reporting accuracy

- Providing narrative and consulting.

- Reporting monthly KPI for COB/OCI, Code Editing and Recoveries

- Perform complex analysis using analytical tools and techniques

Essential Functions:

- Demonstrates leadership and interpersonal communication skills by working collaboratively and effectively with all levels of peers, leadership and outside entities

- Ability to Plans schedule and arrange own activities in accomplishing objectives.

- Ability to understand and influence others regarding existing concepts, process and methodology

- Decision support and participation in requirements and build of new claims platform (Tapestry AP)

- Proficient in systems and research tools to manage data and aid in investigation of

- Identify areas of opportunity to improve overall process within NPI functional areas

- Develops the analysis and definition of efficient, cost effective products/solution that support client-s process and functional requirements.

- Independently initiates, identifies and coordinates the analysis of complex client needs in NPI

- Maintains current knowledge on health care industry, regulations and KP business.

- Makes Recommendations regarding business strategy and policy development

- Measures and tracks key business results and processes against external best practices and assess improvement.

- Works under consultative direction toward predetermined long-range goals

- Develops solutions to problems of unusual complexity, which require a high degree of ingenuity and innovation

Required Skills:
- Leadership skill: Develops strong relationships and leads initiatives that produce business value and drive improvements in program. Has the ability to lead and understand complex systems which impact processing and reporting for business units. Adheres to budgets, schedules, work plans, and performance requirements.

- Presentation skill: continuous audience awareness, ability to convert complex business problems or initiatives into simple, easy-to-follow terms (written and verbally), anticipates reactions to presentation material and drives outcomes and next steps.

- Influencing skill: proposes consistently well thought out alternatives for consideration. Establishes credibility, peers, and stakeholders. Participates in the leadership of cross-functional and/or cross-divisional task forces to drive meaningful and timely outcomes.

- Analytical skill: ability to thoughtfully plan, coordinate, conduct, validate and present analysis of business processes, performance gaps, opportunities for increasing business efficiency in a timely fashion. Comfort with organizing, interpreting, and manipulating data-sets to support conclusions and identify next steps.

- Consulting skill: organizational awareness & stakeholder recognition, active listening, research skill, comfortable in ambiguous settings, self-directed, cross-functional knowledge and effectiveness.

Desired skills:
- Experience with Tableau (preferred) or other analytic reporting tools

- Experience with accessing data from various database systems.

- Highly skilled using MS Excel 2013


Basic Qualifications:
- Minimum ten (10) years of experience, to include a minimum three (3) years in a consulting role.
- Minimum five (5) years of experience in a relevant environment such as a healthcare environment.
- Bachelor's degree required.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A

Additional Requirements:
- Influences multiple cross-functional and/or multiple cross divisional task forces to identify and document functional requirements, workflow, information sources and system/process specifications.
- May establish cross-functional task forces.
- Thorough knowledge of platforms of the assigned functional areas and multiple cross functionally based on assignment.
- Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:
- Certification or advanced qualification by third party association that matches the function or field applicable to the business discipline (such as AHIP or HIAA) preferred.
- Certification by professional society or industry group such as AHIP or HIAA preferred.

Primary Location: California,Rancho Cucamonga,Empire Corporate Plaza 10740 4th St.

Scheduled Hours (1-40): 40

Shift: Day

Working Days: Variable

Schedule: Full-time

Job Type: Standard

Employee Status: Regular

Employee Group: Salaried, Non-Union, Exempt

Job Level: Individual Contributor

Job: Consulting Services / Project/Program Management (Non IT)

Public Department Name: Business Consult/Analyst Spec NPI Reporting

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

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