Business Analyst, PDM
Remote, United States

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 power that brings us to work each day. We believe in embracing new ideas, testing 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. 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 important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign's Corporate Equality Index; was named on the Best Companies for Women to Advance List 2020 by; and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. 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.

Who You’ll Be Working With:

Evolent Health is looking for a Business Analyst, Implementation to be a key team player within the Business Analyst team and 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 end to end enrollment and eligibility functions.

What You’ll Be Doing:

  • Define business requirements and acceptance criteria/test cases that support provider data functions related to State Medicaid and CMS programs based on client and internal defined policies
  • 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 provider data functions 
  • 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 provider functions
  • 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 for provider network data functions in one or more of these programs: Medicaid, Medicare Advantage, Exchange and Commercial
  • Working knowledge of documenting provider network data functions related to one or more of these programs: Medicaid, Exchange, Medicare Advantage and Commercial plans
  • Knowledge of state Medicaid regulations to determine provider meets qualification to be enrolled
  • Knowledge of provider files from State Medicaid programs to decipher provider enrollment and eligibility rules
  • Knowledge of provider type designation identified by the State Medicaid programs
  • 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 Portal functions
  • Knowledge of provider reimbursement methodologies regarding Commercial, CMS and State defined guidelines.
  • 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.

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