Job Description
This position has oversight for the analysis and translation of business needs into business/technical requirements and performing configuration of the approved requirements in FACETS. Leads teams and other resources to ensure alignment of technical solutions with business requirements for complex issues (quantity and magnitude). Acts as a representative of Operations and Configuration to the Enterprise regarding Enterprise Initiatives. This position is responsible for gathering requirements from internal and external clients, providing business and technical expertise in support of the business area, providing configuration expertise during design/build sessions to find the most appropriate solution as well as ensuring that the proposed solutions support and enhance business operations. The Business System Analyst Level 3 elicits, analyzes, performs preliminary testing, communicates and validates requirements for changes to business processes, policies and transaction processing by creating Functional and Configuration documentation including development, technical, and implementation. This person is responsible for ensuring that all tasks are completed in a timely and accurate manner including receiving proper approvals through all control boards. This person works at a senior level of activity and work process coordination and functions independently within authorized limits. May partner with external areas to coordinate work and ensure that deliverables are met and that guidelines/policies are followed. Leads and owns the analysis of complex issues and coordinates the documentation and resolution of business needs.
Performs and oversees the development, testing and implementation of system specifications.
Recommends best practices for delivering Business solutions
Acts as Subject Matter Expert in systems and technologies
Education:
·Bachelor’s Degree preferred (equivalent work experience may be considered)
Work Experience:
·5+ years of health insurance industry experience, preferably in system configuration.
Knowledge:
·Medicare/Medicaid/DSNP preferred
·Requires a minimum of 5 years of experience with claims processing (FACETS Applications preferred)
·Requires a minimum of 3 years of experience translating business requirements into detailed system specifications.
·Thorough knowledge of medical terminology, surgical procedures, CPT/HCPCS, and ICD coding methodologies.
·SQL knowledge and experience is a must.
·Requires strong ability to apply structure to loosely defined complex problems
·Demonstrates understanding of core business functions
Skills:
·Requires skillful configuration execution experience and knowledge
·Requires excellent verbal and written communication skills
·Requires strong organizational and analytical skills
·Requires strong MS Office and technical system skills.
·Clearly articulate (both verbal and written) project status and issues management