Sr. Business Systems Analyst

This job description reflects management's assignment of essential functions, it does not prescribe or restrict the tasks that may be assigned. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. ​

• Advanced to expert level experience in AES programming.
• Intermediate hands-on MS-SQL, able to create queries
• Expert knowledge of the claims data set (eligibility, benefits, contracts, fee schedules, authorizations, claims, NDC, CPT, ICD, UB Rev)
• Ability to build / modify / maintain Athena / IDX Financial Risk Manager application (FRM aka MCA)
• Basic understanding of claims EDI formats (X12) and of claims clearinghouse operation
• Intermediate understanding of claims payment data sets (EOBs and RAs)
• Gathering of business requirements and managing multiple projects
• Exceptional Managed Care experience with time on Claims and A / P
• Advanced knowledge of IDX Dictionaries, Forms / Screens, Rule Banks, DBMS, Cache / IRIS, SQL
• Ensure that all automated processes subscribe to the alerting and logging model appropriate to their category.
• Adhere to policies around knowledge management, work management, change management and source control platforms.
• Maintain or exceed SLAs for assigned work for quality, quantity, and communication measures.
• Excellent verbal and written communication skills required
• Results-driven, customer friendly, approachable and responsive
• Able to deal with ambiguity and problem solve unassisted
• Excellent self-management skills and organizational skills required.
• Experience with Eligibility, Authorizations, Claim and A / P
• Knowledge of payment accuracy systems (Burgess, Cotiviti) a plus
• Individuals must be motivated, able to establish rapport and interact well with individuals on all levels of staff and leadership while maintaining a professional image and attitude.
• Process oriented – adhere to standard work management processes and policies.
• MUST HAVE advanced IDX experience
• MUST HAVE advanced AES programming experience

Provides recognized knowledge of features, functionality and utilization of the application software. Acts as a liaison between Information Technology and business operations to properly align application software design with operational processes. Effectively manages stakeholder expectations through appropriate collaboration and communication. Leads or actively participates in the resolution of complex problems. Ensures the resolution of complex problems are completed in a timely manner. Documents functional and non-functional requirements formally consistent with industry best practices. Maintains a positive working relationship with application end-users and vendor support staff in order to effectively and efficiently resolve or triage service requests in a timely manner. Leads and / or actively participates in the service request resolution decision-making process. Leads and / or actively participates in the management of internal, vendor, consultant, staff-augmentation, and / or outsourced development. Demonstrates sound decision making. Develops and maintains test scripts, in conjunction with end-user subject matter experts, to reflect proposed workflow solutions and verify new release functionality. Reviews and understands new release documentation and leads the testing efforts with end-users to include the development of test scenarios for unit and integrated testing. Provides appropriate on-site support to end-users and business unit management, as necessary, during new release go-live. Provides system maintenance and ongoing updates of required applications for the CRC organization on a nation wide basis. Supports the end-user training team by providing timely updates regarding new software features and functionality. Collaborates with training team to develop job aides utilized for end-user training. Coaches analysis and formal documentation methods with IT staff and Business Stakeholders.

Minimum Experience : Six (6) years of directly related operational, analytical and Core System experience as a Systems or Business Analyst in a Managed Care or Health Care environment. Athena (IDX) a plus, or other Healthcare Core Systems (EPIC, Facets, CSC, MC400, QNXT, EZCap . Successful project involvement. Exposure to re-engineering and process improvement techniques. Working knowledge of relational databases. Familiarity with SQL development a plus. Must have expert level AES experience.

Preferred Education / Experience​

Bachelor’s Degree​​

Experience in a Managed Care environment

Experience with Managed Care Applications or Healthcare Core system - (IDX, Epic, FACETS, NextGen)