Location: Hybrid (Local to NYC or Denver areas) or Remote-US
Position Summary:
The Senior Business Analyst, Government Programs Operations provides support gathering and documenting business and reporting requirements that align with state and federal guidelines. This individual will analyze complex problems and issues using available information from both internal and external sources. Other responsibilities will include – creating specifications documents for business processes, reports, data extracts, and analyses based on business needs. Identify and interpret trends in datasets to find possible outliers or patterns that can be used to drive process improvements. Collaborates with internal and external cross-functional teams (compliance, product, sales, marketing, underwriting, implementation, client services, clinical operations) to design, refine, automate, and maintain operational capabilities.
Position Responsibilities:
Monitors for changes in existing business processes and updates documentation accordingly - Finds new opportunities for process developments and improvements
Intake, analyze and manage requests from stakeholders
Proactively reviews business processes and data to develop subject matter expertise of processes supported by our team
Drives root-cause-analysis and resolution of data and processes issues/errors by partnering with key stakeholders
Supports analytical, problem-solving functions by defining and documenting specifications pertinent to all departmental processes
Analyzes business workflow and system needs for conversions and migrations to ensure that encounter, recovery, and cost savings regulations are met
Prepares end user documentation and training materials as needed
Support encounter and PDE (Prescription Drug Events) submission process by analyzing complex data issues using data from internal and external sources
Develop and set up performance metrics for stakeholder distribution
Performs root cause analysis of claims/encounters processing and submission issues; develops recommendations based on data and industry knowledge
Minimum Qualifications:
3+ years of healthcare experience
3+ years of business process analysis, preferably in healthcare
Demonstratable knowledge of SQL, Excel, and other data visualization tools
Experience with implementation/project management
Experience working with cross-functional teams
Extremely flexible, highly organized, excellent communication and able to shift priorities easily
Attention to detail & commitment to delivering high-quality work product
Comfort or experience in a fast-paced, growing environment
Intellectual and professional curiosity
Familiarity with the agile framework/Certified Scrum Product Owner preferred
Demonstratable knowledge of the Python programming language preferred
Experience with Medicare, Medicaid, and Government Exchange programs preferred
Base Salary: $80,000 - $100,000
About Capital Rx
Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.
Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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