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Commonwealth Care Alliance Business Analyst, Clinical Operations in Boston, Massachusetts

The Clinical Operations Support Department (CS) is responsible for providing analytical and operational support to different departments within Clinical Operations in order to maximize productivity and to ensure regulatory compliance. The team provides other departments with tools and analytics for compliance and continuous improvement, including reports, operational workflows, data analysis, and processes analysis. The CS Business Analyst reports to the Director, Clinical Operations Support. He/She should be a self-starter and effective collaborator, showing strong interest in operations, data analysis and process improvement, strong technical/analytical and problem-solving skills, as well as good written and oral communication skills.

Reports and Tools

  • Develops tools/reports, using tools such as Tableau, Looker, SQL server, (productionalized and ad hoc) for different teams to automate and optimize processes and to track and assess performances (track authorization status, MDS submissions, Hospitalizations, etc)

  • Creates reports to support concurrent and retrospective utilization management.

  • Partners with Clinical Operations management and staff to develop performance metrics reports.

Process Improvement

  • Partners with Clinical Operations management to develop and review workflows, to streamline processes and increase efficiency.

  • Facilitates exploratory sessions to develop a share understanding of a business problem, the possible solutions and next steps. Documents requirements based on the outcome of the sessions.

  • Create Visio diagrams or other visualizations to use in prototype review sessions

Process Monitoring

  • Monitor processes to ensure regulatory compliance, and to identify opportunities for continuous improvement.

Data Analysis

  • Analyzes large sets of data, summarizes and presents results.

  • Develops and analyzes quantitative reports to assess utilization, vendor optimization and adherence to policies and procedures related to various topics such as, authorizations, assessments, procurement, etc.

  • Coordinates and liaises between different teams within Clinical Operations and other departments, when applicable, such, as CCA’s Claims Department, CCA’s Third Party Administrators, IT, Contracting and Provider Relations.

Liaison between Clinical Operations and Other Departments

  • Tracks, analyzes and resolves claims issues related to prior authorizations.

  • Serve as liaison between Business Intelligence team and various departments within Clinical Operations. He/she is expected to translate the business needs into BI requirements for reports, dashboards and tools.

  • Bachelor's Degree in information systems or related quantitative field required (Finance, Business, Computer Science, Mathematics, Economics, or similar)

  • 2+ years experience required.

  • 2+ years of experience in developing and using large relational database modeling concepts and practices (SQL Reporting, or similar)

  • 2+ years of analytical experience with data or statistical analysis in healthcare industry

  • Strong math and analytical skills

  • 2+ years SQL Server programming experience

  • Strong knowledge of structured query language preferred

  • 2+ years of experience with BI products like , Tableau , Alteryx, Looker

  • Health care industry experience

Job Title for Posting: Business Analyst, Clinical Operations

ID: 2020-3433

External Company Name: Commonwealth Care Alliance, Inc.

External Company URL:

Actual Work Location: Lafayette City Center, Boston, MA