Business Consult/Analyst Lead Job in San Diego, California US
Business Consult/Analyst Lead
Bus Cons/Analyst Lead San Diego, CA The Medicare Risk Mitigation Team was developed to understand the end-to-end regulatory expectations for Kaiser's Medicare enrollment and disenrollment functions, study compliance requirements and incorporate into daily operations, perform root cause analysis where patterns of noncompliance are discovered, and begin to achieve process and compliance improvement through creative problem-solving, partnership and learning. The team reviews large samples of the processing work every month and provides real-time quality feedback both before submission to the Centers for Medicare Medicaid Services, and afterward in the form of self-monitoring audits that are reviewed with executive leaders at KP. There is also an evolving need to establish more reporting and analysis both within MRMT and directly supporting the Medicare operations management team and directors. This work will include identifying and assigning monthly audit samples, mainlining audit results and trending in ActiveStrategy, building and maintaining audit databases, developing desktop tools for Medicare operations, and developing control reports, productivity reports, operational dashboard reports, and other required or ad hoc reporting as needed. Essential Functions: - Broad application of principles, theories, and concepts in applicable discipline, plus working knowledge of other related fields. - Uses professional concepts in accordance with company objectives to solve complex problems in creative and effective ways. - This job is the fully-qualified, career-oriented, journey-level position. - Demonstrates expertise in functional area business processes and understands assigned and cross functional areas. - Independently initiates, identifies and coordinates the analysis of complex client needs in project areas such as: new/existing business operating models, innovative approaches to solutions support, market research of emerging or available product functionality and operational readiness assessment. - Identifies opportunities for increasing business efficiency through improved manual and automated process systems. - Coordinates the development of comprehensive business cases with cost, service, and benefit dimensions of proposed projects that are used at management and executive levels for funding and scope decisions. - Accountable for tracking and/or monitor and report for senior mgmt the results of actualization of benefits. - Plans, coordinates and conducts the analysis of client business processes and functional requirements and the preparation of appropriate documentation to communicate and validate the information. - Develops cross-initiative integration plans. - Identifies other initiatives that exist and ensures that efforts are not duplicated. - Supports a variety of applications. - Consults on the integration of application systems into the work environment, regarding their operational and training implications. - Acts as project lead in the coordination of solution development and the implementation of the final product/service. - Acts as a liaison between business clients and technical staff and/or with development staff throughout the development life cycle. - May develop project plans. - Identifies and coordinates within other project managers and implements schedule deadlines as appropriate. - Manages common resource demands. - Provides on-going project management and status reporting at all levels. - Responsibilities impact the achievement of key functional and/or KP objectives that have direct and significant business impact. - Contributes to the development of the department's objectives. - Erroneous decisions or recommendations would normally result in the inability to reach functional objectives and negatively affects expenditures and resources - Chooses, recommends, creates and/or adopts techniques, standards and methodologies to apply. - Makes recommendations for improvements to KP standards/methodologies. - Uses commonalities/differences among team members goals, values, and problem-solving styles to generate multiple alternatives in leading group to achieve a result. - Uses experts or third parties to influence the outcomes or events around them. Solicits the involvement of the people who will be affected by a decision in order to gain their ownership. - Assume other duties as directed. Qualifications: Basic Qualifications: - Total of five (5) to seven (7) years, to include two (2) or more years in a consulting role. - Five (5) years experience in healthcare environment or five (5) plus years of experience working in a department relevant to the current posting. - Bachelor's degree in business/health care administration or related discipline. - Preferred certification or advanced qualification by third party association that matches the function or field applicable to the business discipline - May establish cross-functional task forces. - Thorough knowledge of platforms of the assigned functional area and multi-area functionality based on assignment. - Maintains current knowledge of application systems, interfaces, reporting processes, and data capture. - May support a variety of applications/process. - Coordinates ongoing application support with the various technical areas to ensure continued application/process usage and success. - Maintains current knowledge on health care industry, regulations, and KP business strategies. - Develops test plans. - Provides product/process expertise to client groups, delivers presentations, demonstrations and training for application systems. - Coordinates installation and first-use of new applications/process. - May provide specialized support to a specific business area. - Serves as a single point of contact for the resolution of client issues. - Thinks of ways to improve results, communicates these to supervisor, peers and team members. - Drives excellence through continued learning and strengthening of expertise. - Makes needed changes to address performance problems or take advantage of opportunities. - Seeks ways to reduce variation in systems and processes to improve consistency and reliability, directly impacting performance and member/customer service. - Keeps individuals and team focused on specific and measurable performance goals and monitors performance publicly against clear standards. - Prioritizes project work to meet member/customer needs. - Takes initiative to alter normal procedures to meet specific member/customer needs - Stands by decisions that benefit members/customers even if they are unpopular or impact short term performance. - Continually monitors quality of service across functions and systems. Preferred Skills - Advanced Excel and forecasting/modeling experience - Knowledge of SQL, VBA, ADO, DAO - Experience in Business Objects