HMS makes the healthcare system work better for everyone. We fight fraud,
waste, and abuse so people have access to healthcare—now and in the future.
Using innovative technology and powerful data analytics, we help government
and commercial payers reduce costs, increase quality, and achieve regulatory
compliance. We also help consumers take a more active role in their own
health. Each year, we save our clients billions of dollars while helping
people live healthier lives. At HMS, you will develop new skills and build
your career in a dynamic industry while making a difference in the lives of
We are seeking a talented individual for a Senior Business Analyst of
Reporting who is responsible for analysis, reporting, cost report review,
process improvements, and quality assurance to support HMS Federal in
providing program integrity services to the Medicare and Medicaid programs.
* The role requires an individual with strong analytical and reporting skills.
* The role also requires an individual with strong leadership capabilities, initiative, problem solving skills, and extensive experience with providing reports and analysis to senior level management.
* Coordinate prepare and analyze all operational and management reporting to support HMS Federal program integrity services such as productivity, pending inventory, aging reports, denial rates, and appeal overturn rates, etc.
* Provide root-cause analysis and expertise when compiling and reporting operational results and contract deliverables.
* Develop and maintain a project status reporting system to ensure all contract deliverables are tracked, monitored, and completed timely. Provide status reports to Senior Management detailing the progress and accomplishments in meeting contract deliverables.
* Conduct financial audits and complete writing of working papers on findings. Provide analytical support and ad hoc reporting including design and database queries to extract necessary data.
* Use independent judgment and initiative to review, analyze, and develop solutions for operations and reporting requirements. Identify and quantify the business impact of those solutions.
* Assist with the forecasting as it relates to contract requirements.
* Analyze business functions in order to identify process improvement and/or cost saving opportunities.
* Leverage technology and data to automate processes and improve results.
* Proactively identify and develop solutions to resolve critical issues.
* Identify gaps and recommend enhancements related to new and/or existing technology, processes, and existing products and/or services based on broad view of the organization.
* Influence and promote change in order to improve performance results, organizational effectiveness, and systems/quality/services.
* Assists in the development and maintenance of processes that measure efficiency, productivity, and monitor customer satisfaction.
* Provide systems and report training to staff as requested by management.
* Participates in and contributes to the quality management system.
* Complete law enforcement (LE) requests timely and in accordance with the Program Integrity Manual (PIM), Work Instructions and Policies, Code of Federal Regulations, and HIPAA.
* Review and analyze complaints received to determine the best procedure for investigating the complaint utilizing the following data sources, but not limited to: Cost Report and Financial Information, Work Instructions and Policies, Coverage Determinations, Code of Federal Regulations, CMS Manuals, and other resources.
* Provide subject matter expertise to a team of investigators, medical review nurses, data analysts, and claims analysts to support CMS’s strategy to monitor for and address potential fraud, waste, and abuse in the Medicare program, while identifying overall program vulnerabilities.
* As an essential function, this position is responsible for complying with the company’s Corporate Compliance Program as it applies to the individual job duties, the department, and the company.
* This position will exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates, and/or agents.
* Performs other functions as assigned.
Knowledge, Skills and Abilities:
* Strong analytical and reporting skills with an aptitude for not only delving into the details, but also stepping back to see the big picture to identify issues.
* Knowledge of Medicaid/Medicare Regulations, Claims Processing, and Reimbursement Methodologies preferred.
* Advanced Microsoft Office skills including Access, Excel, Power Point, and Word required.
* Detailed knowledge of the Generally Accepted Governmental Auditing Standards.
* Independent thinker, logical, strategic, with a high focus on problem resolution and attention to detail.
* Outstanding verbal and business writing communication skills as well as strong presentation skills.
* Ability to work independently and within cross-functional teams required.
* Demonstrated ability to meet and exceed project deadlines while producing high quality products.
* Technical writing skills and ability to produce work free from typographical or spelling errors.
* Pro-active and results focused attitude.
* Willingness and ability to work additional hours to ensure reporting deadlines are met.
* Ability to maintain high quality work while meeting strict deadlines.
* Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements.
* Primarily sedentary work with occasional standing, walking, lifting, moving, and traveling to other departments or work sites.
* Demonstrated leadership and management competencies and skills including operational excellence, exceptional communication and customer service skills.
* Demonstrated ability to fluently describe business operations, key trends, and results against plan.
* Demonstrated ability to monitor results and tackle problems directly and with urgency.
Work Conditions and Physical Demands:
* Primarily sedentary work in a general office environment
* Ability to communicate and exchange information
* Ability to comprehend and interpret documents and data
* Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
* Requires manual dexterity to use computer, telephone and peripherals
* May be required to work extended hours for special business needs
* May be required to travel at least 35% of time based on business needs
* The knowledge typically acquired during the course of attaining a Bachelor’s degree in an Accounting or Finance related field is required. A combination of education and experience may be used in lieu of a degree.
* Bachelor’s degree with a minimum of 24 hours of accounting coursework strongly preferred.
* Master’s degree preferred.
* Certified Public Accountant (CPA) designation preferred. 4 additional years experience may be substituted in lieu of CPA designation.
Minimum Related Work Experience:
* 5+ years related work experience with a minimum of 3 years deeply involved in designing, creating, and analyzing reports. Crystal Reports or Business Objects experienced strongly preferred.
* Minimum of 5 years experience conducting audits of healthcare providers with at least 2 years auditing experience under the Generally Accepted Governmental Auditing Standards.
* 5+ years experience working in either fraud examination or Medicaid/Medicare. Experience with data analysis, program integrity, fraud and abuse, and cost avoidance preferred.
* 1 year experience related to Federal Government, State Government, or Managed Care Healthcare contracts required
Nothing in this job description restricts management’s right to assign or
reassign duties and responsibilities to this job at any time.
EOE including disability/veteran
Job Type: Full-time
Pay: $0.00 per hour
* Auditing: 5 years (Required)
* Reporting: 3 years (Required)
* Fully Remote
* Health insurance
* Dental insurance
* Vision insurance
* Retirement plan
* Paid time off
* Work from home
* Flexible schedule
* Parental leave
* Professional development assistance
* Tuition reimbursement
* Monday to Friday
* No weekends
* Day shift
* 8 hour shift
Company’s Facebook page:
* Waiting period may apply