Senior Business Analyst, Delegation Oversight

Job Category:  Provider Relations
Department:  Provider Network Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  4633

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

Under the general direction of the Senior Manager of Delegation Oversight, the Senior Business Analyst, Delegation Oversight is a critical thinker who is responsible for eliciting, analyzing, communicating, testing and verifying requirements for services delivered through contracted, delegated entities (Participating Provider Groups, Management Services Organizations, Vendors, etc.). The Senior Business Analyst is responsible for maintaining a subject matter expertise of the operational, reporting, and accrediting requirements for all lines of business (Medicaid, Medicare, and Commercial) that are delegated to external entities and communicating them clearly to stakeholders, facilitators and partners.

The Senior Business Analyst is required to document each delegated requirement and its corresponding authority source(s), in a comprehensive function-based index that codifies contractual, regulatory, accreditation requirements into major categories, stratifies sub-function level requirements for each product line, and leverages the requirements to monitor and oversight all delegated functions.  The Senior Business Analyst is required to utilize a corresponding standardized template to document a delegated entity’s performance with each requirement identified in the index. The completed form would summarize the manner by which the delegated entity demonstrates compliance with the corresponding requirement, e.g., policy, desktop procedures, workflow(s), and performance measures.

Duties

Elicits, documents, analyzes, communicates, tests and verifies requirements for services delivered through contracted, delegated entities. Assess the requirements of the organization with respect to its operations and functions.  Reviews the LAC PNM organization, and the L.A. Care contracted Plan Partners entity policies, procedures, internal controls, and training materials. Reviews transactions, source documents, disclosures, training and outcomes for compliance with contractual, regulatory, and accrediting requirements, and L.A. Care business policies. Assists with the analysis of delegated entity contracts to identify gaps and opportunities for improved oversight, and is responsible for maintaining documentation to support evidence of compliance with all requirements, and for the reporting of performance data.

Designs and documents business process requirements for all related business, and operational systems critical to core business functions within Provider Network Management (PNM). Analyzes the business processes in an organization for inefficiencies.  Makes recommendations for solutions or improvements that can be accomplished through new process or technology, or alternative uses of existing processes or technology. Identifies opportunities for improving PNM and all delegation oversight processes and using technology to eliminate problems that affect productivity, output, distribution and ultimately, the L.A. Care's bottom line.  Conducts, monitors and oversees assessment activities to review the ongoing performance of processes and controls conducted and implemented by delegated entities parties; assesses these and other activities for compliance with contractual, regulatory, and accrediting requirements, and L.A. Care policies. 

Develops key performance indicators, alerting requirements, and supporting metrics, to proactively inform the Delegation Oversight workgroup, inclusive of L.A. Care’s PNM, Utilization Management, Quality, and Compliance departments, and subsequently inform the Internal Compliance Committee (ICC) of possible risks and issues with compliance, and develop remediation and corrective action plans as appropriate.  Report analytical performance metrics on requirements, which may be in the form of visualizations such as graphs, charts and dashboards, detailing the significant results they deduced to inform senior-level business stakeholders, so they may make informed decisions. Analyzes data in support of business functions, process knowledge, and systems requirements.  Partner with internal L.A. Care departments including Compliance,
Quality Assurance (QA), PNM, Health Services Delivery, and others to ensure providers are compliant with all requirements.  Take proactive preventative steps to resolve issues and manage risk.

Participate in governance committees and other meetings where delegation risk issues are regularly addressed.  Responsible for leveraging and communicating all analysis to aid a diverse set of stakeholders in making informed decisions about which initiatives to implement and how to implement them.

Responsible for the development, implementation, and maintenance of policies and procedures relating to delegation oversight.  Monitors, and analyzes remediation and corrective action plans, and uses critical thinking and problem solving skills to help ensure successful, and compliant delegation partnerships and department quality. 

Support all aspects of monitoring and oversight within L.A. Care.

Perform other duties as assigned.

Education

Bachelor's Degree

Experience

Required:
Bachelor’s in a related field of study; or commensurate work experience.

Equivalent:
In lieu of degree, equivalent education and/or experience may be considered.

Required:
3 - 5 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry; or,
3 - 5 years of healthcare experience in external regulatory or governing entity audit preparation.

Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.

Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.


Required:
Demonstrated critical thinking and problem solving skills.

Strong written and verbal communication skills.

Strong elicitation and process documentation skills

Strong organizational and communication skills to build and foster effective relationships.

Good organizational skills and demonstrate excellent attention to detail and follow up skills.

Knowledgeable financial and financial risk analysis.

Competent computer skills; MS Office skills required.

Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines.

Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel, and LAC provider network physicians.

Possess a professional and mature demeanor at all times.

Ability to work in a fast-paced department independently and handle multiple tasks; work with interruptions and deal effectively with confidential information.

Proven verbal and written communication and presentation skills.

Professional Certifications

Required Training

Additional Information

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

Job Segment: Business Analyst, Medical, Medicare, Medicaid, Finance, Healthcare