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:
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.
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