Business Systems Analyst IV (Benefits Coding)

Horizon Healthcare Services•Newark, NJ

About The Position

This position is responsible for analyzing, understanding and translating business needs into product and benefits requirements. Leads and coordinates teams of other resources to ensure alignment of technical solutions with business requirements for medium to complex issues (quantity and magnitude).

Requirements

High School Diploma/GED required
6-8 years of related IT work experience preferably in the health insurance industry
Demonstrated experience in a key role in major company initiatives and demonstrated leadership experience
Needs strong product and benefit knowledge
Needs strong claims processing skills
Requires knowledge of system development life cycle and implementation methodologies
Requires excellence in structured query languages, or analysis techniques
Requires strong ability to apply structure to loosely defined complex problems
Demonstrates understanding of core business functions
Needs strong communication skills
Needs strong problem solving and analytical skills
Requires skillful project execution experience and knowledge
Requires excellent verbal and written communication skills
Requires knowledge of programming, development, and technical architecture

Nice To Haves

Bachelor degree preferred or relevant experience in lieu of degree
Graduate studies or professional development activities preferred
Prefer experience in benefit coding via HRBK (Via NASCO) or Benefact.
Prefer procedure, diagnostic code knowledge
Preferred Business Analyst Certification

Responsibilities

Lead the process of identifying and recommending coding solutions for enterprise projects and complex benefit coding problems
Validate and approve business requirements
Understand Mandates, Product Development coding grids and BRDs and interpret what is required for benefit updates
Create and deliver work estimates to Project Managers
Document project one-pager dashboards with schedule, budget, blockers, progress
Assist with claims testing scenarios
Document standard operating procedures