Operations Analyst

POSITION SUMMARY

Reporting to the Executive Director, Operations, the Operations Analyst is responsible for completing organizational tasks that support the efforts of the operations department’s projects, activities and tasks. This position requires internal and external collaboration and excellent communication skills. The skill sets required for the Operations Analyst are organized, efficient, and good interpersonal skills. This role will have to think critically to plan, synchronize, and execute activities with a diverse set of individuals in different roles. This position requires a working knowledge of Medi-Cal, Medicare, and county health care programs.

The Operations Analyst general provides support to the department, by conducting specific and comprehensive analyses of a wide range of programs and processes; coordinates and/or performs special projects; recommends policies and procedures; plans, organizes, coordinates, analyzes and implements a variety of assignments and performs related work as assigned.

This role is responsible for independently performing work in a variety of assignments including working on special projects and programs, data review, data analysis and/or research and reporting. Assignments and objectives are established but work methods and resources are left to the incumbents’ discretion. Incumbents may be assigned to work on projects in any Operations department where a need exists.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

• Develop graphs, reports, and presentations in support of department needs.

• Collaborate in tracking of short- and long-range plans and goals and objectives to ensure deadlines are met.

• Identify, analyze, and interpret trends or patterns for methods to better benefit the Plan.

• Coordinate, manage, assist with or support projects that are outside the scope of the Project Management Office.

• Develop and maintain databases necessary for projects and department functions.

• Uses analytical and data skills to produce reports to support the Business in making data driven business decisions.

• Develop graphs, adhoc and regularly schedule reports, and presentations of project results.

• Reviews data to ensure validity.

• Perform basic statistical analyses for projects and reports.

• Performs basic analyses on departmental productivity.

• Extract and analyze data from various sources to achieve cost saving programs for the Plan.

• Generate routine and ad hoc reports as assigned.

• Maintains an UpToDate and thorough knowledge of Gold Coast Health Plan's policies as related to department

• Provides accurate research to resolve issues regarding, claims and contracting using appropriate systems.

• Properly documents all calls/contacts as required by department standards in a clear and concise manner.

• Oversee projects and prioritize the resources to optimize the use of those resources to maximize effectiveness.

• Communicate effectively in writing, orally, and with others to understand and/or convey information in a manner consistent with job functions.

• Establish contact lists of collaborators and update information periodically.

• Maintains an up-to-date and thorough knowledge of Gold Coast Health Plan's guidelines.

• Attends departmental meetings and training sessions as required.

• Coordinates the oversight initiatives and Joint Operating Meetings

• Establishes telephonic, electronic correspondence and/or fax contact with internal and external customers following internal policies and HIPAA guidelines

• Maintains an up-to-date and thorough knowledge of Gold Coast Health Plan's guidelines.

• Provides accurate research to resolve operational issues.

• Critical thinking skills as demonstrated by the ability to problem-solve complex, multifaceted situations.

• Attends departmental meetings and training sessions as required.

• Respond to calls from providers, members, and internal customers.

• Identify appropriate escalation path and escalate internally to the correct department as needed

• Maintains strict confidentiality of all sensitive information.

• Write internal documents as needed.

• Other duties as assigned.

POSITION QUALIFICATIONS

Competency Statements

• Interpersonal - Ability to get along well with a variety of personalities and individuals.

• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

• Consensus Building - Ability to bring about group solidarity to achieve a goal.

• Relationship Building - Ability to effectively build relationships with customers and co-workers.

• Presentation Skills - Ability to effectively present information publicly.

• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

• Judgment - The ability to formulate a sound decision using the available information.

• Communication, Oral - Ability to communicate effectively with others using the spoken word.

• Communication, Written - Ability to communicate in writing clearly and concisely.

• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

SKILLS & ABILITIES

Education:

• Bachelor's Degree (four-year college or technical school) Preferred not required, • Field of Study: Health Care Administration, Health Care Economics, or related discipline.

• 3-5 years of experience in managed care environment, or one that would have developed the knowledge and abilities listed.

• 2-3 years in data analysis in a managed health care environment preferred

Experience:

• Principles and practices of managed health care.

• State and federal laws and/or regulations as they relate to managed care, Medi- Cal/Medicaid and other related business and policies governing managed care issues.

Computer Skills: Advanced computer skills included in the MS Office products (Word, Excel, Access, and PowerPoint).

Certifications & Licenses:

Other Requirements:

• Provide on-going information/reports to Management as requested.

• Ability to work collaboratively with others.

• Focused and thorough research skills.

• Prioritize tasks in order to meet deadlines.

• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

• Written Communication - Writes clearly and informatively.

WORK ENVIRONMENT

Office work environment.