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General Information

Work Location: Los Angeles, CA, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday - Friday, 8:00am - 5:00pm PST
Posted Date
05/06/2025
Salary Range: $78500 - 163600 Annually
Employment Type
2 - Staff: Career
Duration
indefinite
Job #
24119

Primary Duties and Responsibilities

The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and external partners. This role is responsible for gathering and documenting business and system requirements, analyzing and interpreting data to support cross-functional operations, and driving system enhancements to improve efficiency and compliance. The analyst will also support testing, report generation, and documentation efforts related to software and process improvements.

Key Responsibilities:
  • Gather and define business and technical requirements to support electronic data exchanges and system enhancements
  • Collaborate across teams to design and implement effective business solutions
  • Develop documentation including business cases, test cases, and process flows
  • Perform data analysis and reporting to support operational decisions
  • Lead and support audits, quality control initiatives, and performance improvement efforts
  • Coordinate with IT and trading partners to implement Tapestry ISS and other system enhancements
  • Ensure compliance with organizational policies and regulatory standards

Salary Range: $76,200 - $158,800/Annually

Job Qualifications

  • Bachelor’s Degree in Business Administration, Information Systems, Health Care or other related field required
  • Minimum of five years’ experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required
  • Minimum of five years’ experience with CMS processes in a Medicare or Managed Care environment required
  • Experience with CMS processes is a plus
  • Knowledge of SQL window-based computer environment including MS Office and related programs is a plus
  • Knowledge of encounter regulatory reporting and compliance requirements.
  • Experience managing vendors to contractual requirements.
  • Strong ability to research and resolve encounter issues.
  • Strong knowledge of the health care model, capitation and other managed care IPA and provider reimbursement methodologies.
  • Strong knowledge of physician and facility billing practices, appropriate CPT coding initiatives, ICD-10 coding standards, as well as Revenue and HCPCS coding.
  • Strong leadership skills, with the ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, anticipate consequences, and meet deadlines.
  • Demonstrated ability to analyze and organize complex federal and private insurance regulations.
  • Working knowledge of Microsoft Office Suite (Excel, Word, and PowerPoint) and data visualization tools.
  • Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities and deadlines.
  • Reliability and compliance with scheduling standards. 
  • Strong critical thinking and the ability to apply knowledge at a broad level within a complex academic medical center is essential. 
  • Ability to develop, implement, and evaluate methods and systems to improve efficiency.
  • Proven skills to lead and facilitate cross-functional workgroups and other meetings.
  • Ability to analyze and organize complex federal and private insurance regulations.
  • Must be effective at working independently with minimal supervision.
  • Ability to support the working hours of the department.
  • Ability to travel/attend off-site meetings and conferences.
  • Must be customer service oriented, be able to work well individually and as part of a team; and have a strong work ethic.