Business Analyst (Remote)

Serigor•Philadelphia, PA

1d•Remote

About The Position

Seeking a strong Business Analyst to support BlueCard daily operations. This support will assist to move forward resolution of operational challenges, improve current processes, and support project management initiatives. You will work closely with other team members and cross-functional teams such as configuration and Account Management to resolve discrepancies and improve the claims processing experience for BlueCard members.

Requirements

3 years or more of experience in medical claims processing and adjusting or healthcare administration.
Expertise in the Blue Squared application.
Knowledge of medical billing codes (ICD-10, CPT, HCPCS), claims processing software, and a strong understanding of the BlueCard product.
Ability to summarize large amounts of data and pivot data in multiple ways.
Ability to assess claim data in detail and identify errors or inefficiencies.
Possess excellent mathematical skills and have the ability to work independently and within tight timeframes.
Strong written and verbal communication skills for interacting with various stakeholders and resolving issues quickly.
High level of accuracy and thoroughness in reviewing claims for clients.
Advanced skills in Microsoft Office and Microsoft platforms (Excel, Word, PowerPoint) required.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
BlueCard experience – the client's primary screening point.
Claims knowledge.
Healthcare industry experience.
Blue Squared application (BCBSA / RTM) – expertise.
Root cause analysis on incorrectly processed claims, failed DF and RFs.
Summarising and pivoting large data sets.
Advanced Microsoft Office – Excel, Word, PowerPoint.

Nice To Haves

Working experience with SQL and Access preferred.
Experience with technologies, desktop tools and/or Operations processes and technology is helpful.
Knowledge of BCBSA and how the BlueCard system works end to end, including partnering with host plans.
Experience with a Pennsylvania Blue plan.
Able to hit the ground running and provide strong support to a close but overwhelmed team.
Ability to work independently and within tight timeframes.
Strong written and verbal communication for interacting with various stakeholders and resolving issues quickly.
High level of accuracy and thoroughness.
SQL.
Microsoft Access.
Process improvement using data, Bots and applications/tools.
Experience with a Pennsylvania Blue plan.

Responsibilities

Support the processing team with analysis of claim issues and inquiries.
Perform root cause analysis and course correct identified issues for full resolution.
Work with other plans to resolve issues for members.
Research root cause of incorrectly processed claims, failed DF and RFs.
Provide solution and coordinate with appropriate team members to repair the claim and provide re-education to the processor or submit ticket for system enhancement.
Focus on applying technologies to continuously increase claims process improvements with the use of data, Bots and applications/tools.
Share this knowledge and skill with other team members to instill across the team the opportunities that they can escalate to process improve.
Schedule reoccurring meetings to keep momentum.
Responsible for evaluating current business processes and developing, implementing, testing and maintaining Technology for more cost effective or quality improvement processing.
Assist with pulling needed data and assist with the documentation of processes and work procedures.
Represent Department as SME in meetings, projects and company initiatives.
Communicate with other plans via the Blue Squared BCBSA Application (RTM).
Perform other duties as assigned.