Sr Business Analyst Care Management - APPLY BELOW

 

Projé is continually growing therefore, we are currently seeking a qualified, highly motivated, experienced individual for the position of Sr. Business Analyst – Care Management. This position requires Monday through Thursday travel to the client site.

 

This position will play an essential role in our clients’ projects. Employing expertise, discretion and independent judgment, the Business Analyst is responsible for working with client resources and the Project Manager in gathering and documenting requirements for the Health Plan processes, including but not limited to, claims processing, clinical editing, case management, disease management, utilization management, and enrollment. Responsible for conducting and reporting on internal/external audits, reports and other documents; providing compliance advice to project teams; and assisting with other departmental needs. Supports system configuration changes and quality assurance testing, and ensures accuracy of standard and custom reports. Works with the Project Manager and users to develop or modify data, information and functions to meet the Health Plan’s needs. Performs data validation and quality review. Provides technical expertise and recommendations in assessing software projects and initiatives to support and enhance systems. Identifies opportunities to improve efficiencies and business processes. Troubleshoots applications and issues, and identifies modifications needed to meet changing user and regulatory requirements. Creates enhancement and change requests for projects, provides assistance with implementing enhancements and ensuring departments implement new processes supporting the changes. Assists in assessment, planning, project communications, analysis, testing, training and implementation.

 

Responsibilities

  • Uses extensive business knowledge and effective communication skills to facilitate and elicit requirements for projects, while effectively managing changes and conflicts during specifications gathering process.

  • Works directly with end users to evaluate customer or plan needs.

  • Conducts the analysis and documentation of current state and future state, documenting 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.

  • Organizes and synthesizes large amounts of information provided by stakeholders into presentation material.

  • Develops business process artifacts (process flow, work state diagrams, etc.) as they pertain to enterprise-level processes, spanning multiple functional areas.

  • Documents and implements process improvements and control documentation for traceability and future reuse.

  • Develop use cases, test scenarios, test cases, clearly communicate testing methodologies and apply testing methodologies to ensure application quality.

  • Identify, communicate and escalate risks and issues that may require changes to project plans or scope.

  • Reviews requests to ensure consistency and compatibility to existing systems and procedures, including researching, validating and resolving issues, for accurate processing of information. Communicates and escalates information from all levels (leadership to end-users).

  • Establishes and maintains collaborative relationships with all associated departments, workgroups, and vendors as required. Communicates effectively and concisely to promote positive relationships.

  • Participates in meetings and presentations effectively and professionally. Provides documentation for meetings to report progress, issues and possible resolution.

  • Supports clinicians, managers, Project Managers and end-user timelines for assigned tasks. Manages time and activities effectively and efficiently; prioritizes, plans and organizes work, to ensure deliverables are completed on time, while producing high quality results. Creates status of tasks, as well as risks and issues.

  • Troubleshoots technical issues, and identifies modifications needed in existing applications to meet changing user and regulatory requirements.

  • Provides assistance with implementing enhancements and ensuring departments implement new processes supporting the changes.

  • Demonstrates and promotes a positive approach to change. Works with clinicians, managers, and Project Managers to deliver changes/project needs.

  • Monitors, reports and collaborates with users/departments to formulate corrective actions for issues.

  • Assists in the education and training of end-users.

  • Maintains up-to-date knowledge of current trends, and issues in healthcare, national and statewide standards and legislations, changing policies and procedures.

 

Education and Experience

  • Minimum of 5 years work experience in an analyst or development capacity.

  • Exemplary knowledge, and a minimum of 10 years of experience in many functional areas of health insurance.

  • Bachelor’s degree in healthcare administration or a related field or equivalent experience.

  • IIBA and/or Six Sigma certification preferred, and knowledge of formal business process improvement.

 

Key Qualifications

  • Solid understanding of payers in the health insurance space. Experience eliciting requirements from business users, to define and document project requirements.

  • Knowledge of computer software systems and applications, as well as database set-up and management.

  • Expert skills with MS Office Suite, Visio, MS Project, and SharePoint required.

  • Proven skills in data analysis and presentation of data, with the ability to produce high-level visuals and diagrams, as needed.

  • Proven success in multiple project implementations.

  • Superior task management skills, with the ability to work under pressure, independently or as part of a team in situations in which multiple priorities are likely.

  • Solid analytical skills; able to translate analysis into outcome into definable, functional requirements or effective business processes.  Exemplary troubleshooting and problem resolution ability

  • Proven excellence in organizational skills. Meticulous attention to detail, with the ability to produce accurate and precise work and detect and resolve discrepancies, while meeting deadlines.

  • Strong analytical, problem solving, negotiation and collaboration skills. Proven ability to participate in several projects at the same time.

  • Superb written and verbal English language communication skills, as well as interpersonal skills. 

  • Strong ability to communicate and influence without authority.

  • Effectively and concisely communicate with the business through verbal, written and face-to-face communication.

  • Expert in the presentation of configuration ideas, status, solution and results.

  • Proven experience in two or more of the following: ICD-10, Medicaid, Medicare, BCBS, ITS, FEP, knowledge of healthcare governmental strategy and business model.

 

Desired Skills & Experience

 

  • CM, DM, and UM

  • Clinical Software Implementations

  • Clinical Business Process Modeling/Workflows

  • PPACA/HCR

  • Exchange Experience

  • ICD-9 to ICD-10 Conversion

  • EDI/HIPAA Transactions

  • Experience with Medicare-Medicaid, BCBS, HIPAA, ITS and FEP Projects