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Evolent Health Sr. Business Analyst, Claims in Topeka, Kansas

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

It’s Time For A Change…

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. We bring our whole selves to work and we’re driven to make a difference every day, from the work we do in our roles to the charitable endeavors we support. We believe in starting by listening, communicating with candor, fostering inclusion, and owning the opportunity. We respect and celebrate individual talents and team wins. Whether we’re wearing scrubs, jeans, or our finest work-from-home chic, we have fun, work hard, and make time to help others.

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving diversity, equity, and inclusion (DE&I) efforts. Evolent achieved a 100% score on the 2020 Human Rights Campaign's Corporate Equality Index, making us one of the best places to work for LGBTQ+ employees. We were also named on the Best Companies for Women to Advance List 2020 by Parity.org and we publish an annual Diversity Report to share our progress on how we’re building an equitable workplace and performing on various metrics. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Who You’ll Be Working with:

Evolent Health is looking for a Sr. Business Analyst, Claims to be responsible for requirements management of the implementation work across our client and Evolent organizations. This individual will be responsible for building and managing requirements for new and existing client implementations with emphasis on data interfaces.

What You’ll Be Doing:

  • Define business requirements and acceptance criteria/test cases that support data interfaces related to healthcare business platform

  • Define business requirements and acceptance criteria/test cases that support Vendor interfaces related to healthcare business platform

  • Perform business analysis of identified process and software gaps or inefficiencies and develop plans to fill those gaps for internal business processes and for external clients

  • Research, interpret and summarize state and/or CMS regulations related to Medicaid, Medicare Advantage, and Exchange programs with emphasis on data interfaces

  • Perform requirements review with external and internal stakeholders and obtain sign off from all required individuals

  • Create and standardize business requirements documentation processes and workflows

  • Manage BRD deadlines with necessary tools for completion tracking and clearly identifying open items that need inputs from stakeholders

  • Collaborate with internal and external stakeholders to gather requirements pertaining to data interfaces

  • Collaborate and work closely with Project Managers and Evolent business teams

  • Identify issues upfront and communicate clearly to the management

  • Participates in the management of the sequencing of releases to meet business needs for enhancements, automations, and implementations

  • Ensures continuing operational support by documenting changes and enhancements

  • Provide training to staff on need basis and act as a mentor for new team members

The Experience You’ll Need (Required):

  • Extensive knowledge in health insurance third party administrator concepts related to EDI or custom data interfaces in one or more of these programs: Medicaid, Medicare Advantage, Exchange and Commercial

  • Working knowledge of documenting data element requirements, rules pertaining to these data elements and applicable regulations outlined based on state and CMS guidelines

  • Working knowledge of setting up communications for EDI transmissions using FTP, SFTP and real time API setups

  • Knowledge of provider files from State Medicaid programs to decipher provider enrollment and eligibility rules

  • Knowledge of provider extracts sent to state vendors to reflect the accurate provider network used for open member enrollment regarding Medicaid program

  • Knowledge of health insurance, HMO and managed care principles including Medicaid and Medicare regulation

  • Knowledge of provider matching criteria for claims

  • Strong communication and facilitation skills

  • Strong time management and organizational skills

  • Excellent interpersonal, oral, and written communication skills

  • Strong attention to detail and organization

  • Able to work independently and within a collaborative team environment with little guidance/supervision

  • 2+ years of computer skills, especially: Word, Excel, Visio, Power Point, and SharePoint

  • 3+ years of experience leading projects and cross functional teams

  • Ability to successfully balance deadlines, projects, and day to day responsibilities

Finishing Touches (Preferred):

  • Associate or Bachelor’s degree preferred

  • Certified Business Analyst is strongly preferred, equivalent demonstrated business analysis experience

  • Extensive experience with the System Design Life Cycle (SDLC) or any other industry standard for implementations

  • Superior root cause analysis skills, including corrective action planning and ability to provide documentation to support analysis

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. Evolent Health maintains a drug-free workplace.

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements. Evolent expects all employees to also comply. We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home. Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes. Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

Compensation Range:

The typical range of employees within the compensation grade of this position is $70,000 - $90,000. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.

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