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Business System Analyst At Calabria Group

Location: Monterey Park, California

Job Description

Business System Analyst acts as a SME to be responsible to gather, analyze, and document the business and system requirements, conduct data analyses, and identify all gaps among submissions, internal exclusions, and regulators’ responses; and reconcile the volume charts and all submissions from hospitals. The Sr. Business System Analyst is responsible to support Sr. Programmer Analyst by providing all business and system requirements, QA/UAT any relevant process and data/report results; and work with all internal and external stakeholders to ensure the success of this project accurately and timely.


Minimum and Preferred Qualifications:


Education:

  • Minimum Bachelor's degree in Computer Science, Information Technology (IT) or related discipline that includes technology concentrations from an accredited university

  • A Master’s degree in Computer Science related discipline is desirable.


Experience/Skills:

  • Minimum of 7years related experience working in a managed care environment, preferably in a data analysis, operation management, and informatics position

  • Minimum of 7 years prior experience with State and Federal regulatory data standards and requirements

  • Ability to comprehend and work with HIPAA standard transaction sets, specifically 837P, 837I

  • Knowledge of healthcare management in IPA, Hospital, Provider Network Operations, Member Enrollment, Claim Process, Medical Payment and Revenue Reporting, and Encounter submissions and measures

  • Proficient in MS Access and Oracle database, SQL, and MS Office

  • Ability to conduct comprehensive data analyses, find the root causes of the rejections and issues, and interpret business requirements, data, to identify the opportunities for the gap analyses

  • Lead, manage, and assist all aspects of the project, including gathering business and system requirements, translate to functional requirements, support Sr. Programmer analyst to reconcile all volume charts and hospital encounter submissions

  • Ability to take the initiatives to develop methodologies, strategic plan to optimize the process and performance

  • Ability to write analytical reports and comprehensive summaries

  • Ability to effectively communicate with management and staff, as well as with external submitters

  • Ability to prioritize and lead multiple projects concurrently

  • Able to work in a fast paced environment with frequently changing work demands