Business Analyst – Clinical Operations – Remote


Business Analyst – Clinical Operations – Remote


Remote | Remote
United States

Job Details


When it comes to making a meaningful difference in the lives of our customers and employees, USAble Life (a Life & Specialty Ventures Company) is always ready.

At USAble Life, we strive to have a positive impact in the lives of others, especially our employees. We are a diverse group of individuals working together to go the extra mile.  Bring your talents and expertise to join our team, and you’ll be rewarded with opportunities for personal and professional development. Our passion for delivering the best products is matched by our passion for our people.

USAble Life has made Arkansas Business Magazine’s list of “Best Places to Work” for an impressive fifth consecutive year in a row!  This, coupled with our engaging culture and a comprehensive benefits package, ensures we are committed to our employees.

Business Analyst – Clinical Operations Overview

  • Responsible for supporting LSV’s collection of information and response to Fraud, Waste and Abuse (FWA) and patient complaints requiring clinical review arising from Blues partners, UCD, miscellaneous and internal sources.
  • Supports compilation of complete data from internal and external third parties for FWA reviews.
  • Supports State and Regional Dental Directors and VP, National Clinical Operations.
  • Supports functional activities for research from writing data requirements, gathering dataset elements, and assisting with statistical analysis.
  • Supports Foundation partnerships related to clinical activities and all continuing education programs.
  • Supports researching and documenting clinical care components based on dental practice Acts in each state.
  • Supports creating of training sessions and as needed, teaches appropriate audiences.
  • This is a remote position.

 Essential Duties:

  • Process Oversight: Supports all clinical appeals, patient complaints related to clinical activities, standards of care and practice trend FWA activities beginning with intake from source to final determination and provider education, where needed. Compiles reporting outcomes and provides to Director, Clinical Operations for team review.
  • Medicare FWA Compliance: Supports collection of data to identify and address Medicare complaints and Utilization Reviews.
  • Reporting and Analytics: Supports the development and production of Clinical Operations analytics and ensures timely and accurate reporting of results for external and internal consumption and distribution. Continually evaluates analytics to identify FWA. Identifies process improvements to achieve greater levels of compliance, overall appropriateness of care, and total departmental costs.
  • Professional education, Foundation engagement and Research: Supports Director, Clinical Operations with activities supporting community service and continuing education.
  • Operational Management: Supports the day-to-day operations of Clinical Operations. Evaluates, recommends and supports implementation of continuous improvement of Clinical Operations processes including increased levels of automation.

 Required Knowledge, Skills and Abilities 

  • Must be able to work with and form strong collaborative relationships with external and internal business partners.
  • Motivated and innovative; seeking out opportunities to improve or enhance existing processes.
  • Basic knowledge in information gathering, planning, and organizing methods and principles.
  • Excellent communication and interpersonal skills including the ability to address a wide range of audiences.
  • Intermediate skills in MS Office Word, Excel, Power Point, Visio, and Project.
  • Motivated self-starter with the ability to prioritize workflow, multi-task, and maintain attention to detail within time constraints.
  • Ability to work independently on multiple tasks in a fast-paced environment.
  • Ability to think critically and problem solve.

 Required Education and Experience

  • Bachelor’s Degree in Healthcare Administration, Healthcare Claims Investigations or related field, or equivalent related experience
  • Experience with supporting multiple programs and development of programs
  • Or equivalent military experience

 Preferred Education and Experience

  • 1-2 years of business and/or systems analysis and documentation experience.
  • Bachelor’s Degree in Healthcare Administration or business-related field
  • Demonstration of results oriented collaborative processes

USAble Life employees are required to be fully vaccinated against COVID-19 as a condition of employment unless an employee qualifies for an exception as an accommodation for religious or medical reasons. This requirement applies regardless of work location. The Centers for Disease Control and Prevention (CDC) currently defines people as “fully vaccinated” for COVID-19 two weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or two weeks after they have received a single-dose vaccine (Johnson & Johnson [J&J]/Janssen).


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