Sr Business Analyst

Remote With Possible Future Travel • Full-time

Projé, Inc. is a woman-owned, consulting firm providing advisory consulting services, project management, and analytical business resources in the health care industry. As a trusted advisor, Projé provides the knowledge, skills, and leadership to help clients achieve their goals.

Projé offers a strong team centered culture, focused on meeting project deliverables with excellence.

Projé has an exciting opportunity for a full-time Senior Business Analyst. This is a remote position and requires weekly travel to the client site Monday through Thursday. The Senior Business Analyst will assist in the assessment, analysis, testing and requirements gathering and documentation processes for the Health Plan operations. The ideal candidate will possess detailed knowledge of claims, clinical editing, utilization management and enrollment. 

Responsibilities 

Conducts the analysis and documentation of current state and future state, documenting gaps and user requirements in the design of the future state workflows, to optimize system functionality.  
Along with the client, modifies or creates new workflows and testing to improve processes. 
Facilitates and elicits requirements for projects, while effectively managing changes and conflicts during specifications gathering process. 
Completes the design, development, documentation, analysis, creation, testing or modification of computer systems or programs, including porotypes, based on and related to user or system design specifications. 
Responsible for the design, documentation, testing, creation or modification of computer programs testing, creation or modification of computer programs related to machine operating systems 
Develops use cases, test scenarios, test cases, clearly communicate testing methodologies and apply testing methodologies to ensure application quality. 
Manages Clinical Business Process Modeling/Workflows utilizing Microsoft Visio 
Develops and documents Desk Level Procedures and Standard Operational Procedures 
Participates in meetings and presentations effectively and professionally.  Provide documentation for meetings to report progress, issues and possible resolution. 
Applies system analysis techniques and procedure, including consulting with users to determine hardware, software or system functional specifications 
Establishes and maintains collaborative relationships with all associated departments, workgroups, and vendors as required. Communicates effectively and concisely to promote positive relationships. 
Supports clinicians, managers, project managers and end-user timelines for assigned tasks

Key Qualifications 

Solid understanding of health plan (payer) clinical operations in the health insurance space 
In-depth understanding of Health Plan processes, including but not limited to, claims processing, clinical editing, utilization management and enrollment. 
Knowledgeable in Healthcare Effectiveness Data and Information Set, Utilization Review Accreditation Commission, and National Committee for Quality Assurance 
Strong analytical, problem solving, negotiation and collaboration skills. 
Proven ability to participate in several projects at the same time. 
Expert skills with MS Office Suite, Visio, MS Project, and SharePoint required. 
Experienced in Medicare, Medicare Advantage, and Medicaid. 
Knowledge of Health plan software systems including Facets, QNXT, and/or Care Management systems

Perks  

Competitive pay and bonuses  
Excellent benefits (medical, dental, vision)  
401K with percentage company match  
Paid holidays and vacation days  
Flexible schedule

Education and Experience 

A minimum of 10 years of Health Plan experience is preferred. 
A Bachelor’s degree in Healthcare Administration or a related field is required.  Equivalent experience may be considered in lieu of a bachelor’s degree.

We get projects done, and help people along the way.

We work with payors and providers to manage, implement, test, and deploy systems that provide increased efficiency, process improvements, and high quality outcomes.

We are committed to achieving project deliverables and take pride in our clients’ success.

Since our founding in 2004, Projé has built a stellar reputation of excellence through the dedication and commitment of our expert consultants who live out Projé’s mission every day.

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