Business Analyst (Medicare Risk Adjustment & Encounters) job – Health Net, Inc. – Rancho Cordova, CA

Business Analyst (Medicare Risk Adjustment & Encounters)

Health Net, Inc.

629 reviews

Rancho Cordova, CA 95670


Job Summary

  • The Business Analyst represents a business specialty or function on formal project teams, and is responsible for gathering and analyzing data, defining business specifications, and analyzing and documenting business processes. Responsibilities also include researching, planning, preparing status reports, and writing project documentation.

Essential Duties & Responsibilities

  • Identifies, evaluates and documents business needs and objectives, operational processes and procedures, problems and requirements.
  • Recommends operational and process improvements based on efficiencies and available technologies.
  • Maintains a repository of performance metrics, and generates management reports illustrating statistical data, text and graphics
  • Conducts secondary research using a variety of publications, services and health statistic databases.
  • Produces documentation, including project plans, analytical reports, decision backup, information research reports, budget analyses, training plans, business justifications, and graphics.
  • Education

    • Bachelor’s Degree in Business, Health Administration, Marketing, Finance, or related field required

    Certification/Licensure Required


    Government Clearance & US Citizenship Requirement


    Experience Required

    • Minimum two years experience in cross-functional business analysis and reporting
    • OR, any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

    Knowledge, Skills & Abilities

    • Ability to collect, analyze and present data
    • Ability to conduct business studies and recommend solutions
    • Strong analytical and problem solving skills
    • Knowledge of functional area policies, procedures, processes, and standards
    • Excellent writing skills for preparing narrative reports and correspondence
    • Abilities in math, accounting and/or financial principles
    • Knowledge of process improvement, workflow, benchmarking and evaluation processes
    • Knowledge and ability to apply advanced features of PC based programs and database management systems. PLSQL and KBase skills preferred
    • Knowledge of insurance products: Commercial, Medicare, Medi-Cal, ACA and/or Duals preferred
    • Demonstrated ability to prioritize and manage multiple responsibilities and deadlines

    Working Conditions

    • The following section describes the general physical requirements for this position. Please note that ‘constant’ refers to more than 81% of time; ‘significant‘ refers to 40-80%; and ‘moderate’ refers to 20-40% of the time.
    • Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
    • Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
    • May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays).
    • May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
    • Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
    • Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
    • Required to have hearing ability to receive detailed information through oral communication.
    • Required to have speaking ability to express or exchange ideas.
    • Constant concentration may be required on various subjects by listening, reading and thinking clearly.
    • Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
    • Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
    • Constant computer usage including typing and/or eye strain.
    • Constant repetitive arm, wrist, hand and finger motions — making repetitive movements (e.g. key boarding, filing, data entry).
    • Constant phone usage; headsets may be required.
    • Moderate amount of time spent working in a loud office environment with frequent interruptions/distractions.
    • Constant sedentary work (desk bound or seated).
    • Constant reading is required via computer screen and/or bound printed materials.


    DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.

    Location: Rancho Cordova, CA

    Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer – Minorities/Females/Veterans/Disability

    629 reviews

    Health Net has woven together a web of health plan services. The company provides managed health care medical coverage to about 6 million…

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    A Computer Programmer whose articles got mentions from the likes of The New York Times, Kissmetrics and AllTopStories. He writes articles, novels and poems; spends most of his time reading everything he could get his hands on. He is currently pursuing his Masters from The University of Illinois and holds a Bachelors in Electronics Engineering from the University of California. He is a programmer, a motivational writer and speaker.

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