Claims Bus Tech Analyst II

Horizon Healthcare Services•Newark, NJ

13h•Onsite

About The Position

This technical analyst position is required in order to create a critically needed Service Division Claims Business Technical team to support the successful implementation of automation and efficiency projects/programs to ensure the achievement of claims timeliness and quality goals. Responsible for coordination throughout the Service Division of all Claims Operations' technical requirements including global inventory reporting and aged claims analysis; claims stop governance, monitoring and maintenance; NASCO issue coordination and system request prioritization, submission and installation; files and table management; BRD review and subject matter expertise; Open Connect and BPM opportunity assessment and execution; EDI gateway claim edit project assessment and completion; general business level technical support for CSRs, PLogs, configuration, file updates and other projects.

Requirements

High School Diploma/GED required
Requires broad-based Operations or IT experience with a minimum of 5 years in managed healthcare or related industry.
In lieu of Bachelors degree, an additional 3 years of experience in Operations or IT is required.
Claims systems knowledge is required
Requires broad understanding of claims systems and related ancillary systems used in the Service Division
Requires business and/or technical expertise from previous claims projects and work flow changes and impacts
Requires knowledge of the deep understanding of the NASCO or FACETS system
Requires knowledge of project management life cycles and related tools and practices
Must have a solid understanding of claim processing including pricing and code editing
Must have strong organizational and analytical skills and demonstrated ability to effectively manage multiple projects at one time
Must have strong inter-personal skills with a demonstrated ability to lead cross-divisional work teams
Must demonstrate an understanding of the interdependences between the business, clinical and financial side of the health care business
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint, MS Project) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications:
Must have a working knowledge of the impacts of mandates and legislation on overall claims processing and contracting
Requires technical proficiency in Horizon claims operating models
Requires excellent coordination management and organizational skills
Requires strong analytical and problem solving skills
Require excellent conflict management and relationship management skills
Requires excellent facilitation, coaching and platform skills
Requires strong project management skills based on Horizon project management practices
Requires ability to work on a matrix-managed project team

Nice To Haves

Bachelor degree preferred or relevant experience in lieu of degree
Successful track record in managing operations with process improvement background desired.
Past experience on system implementations in a fast-paced, high pressure environment is preferred.
Project management experience is a plus
Experience with specialty health plan products/groups helpful
Prior background in managing change and developing new operations is preferred

Responsibilities

Provides business technical support to operations across the Service Division to ensure successful implementation of automation and efficiency projects/programs to ensure the achievement of claims timeliness and quality goals.
Works with Service departments to coordinate prioritization of projects and works with IT and Claims System vendors (NASCO) for implementation and maintenance.
May conduct User Acceptance Testing (UAT) for Service Division projects, implementations, system fixes and enhancements.
Collaborates with the business groups to develop, document and standardize reporting procedures and workflows to support operational improvement
Manages Claims Stop governance and maintenance to minimize claims stops and assure discipline, documentation and audit trail.
Leverages existing technology by identifying opportunities to automate manual processes and interventions; identify opportunities to incorporate and standardize new technology into processes and flows
Creates opportunities by working with IT on new solutions and business on EDI gateway claim editing possibilities.
Works with IT and corporate departments to help monitor service level agreements on Plog timeliness; recommends alternate approaches for handling for effectively.
Work across Service departments to achieve business goals; leverage key internal and external relationships to access the information, products and resources (technology, training, staff, etc.) necessary to successfully support Claims and related Service goals.
Reviews BRDs and offers commentary as required.
Provides Subject Matter expertise to Service teams as needed on business technical issues and audit activities.
Prepare materials for internal and external audit activities, review audit findings/reports for accuracy and completeness. If appropriate, formulate rebuttal and/or corrective actions steps.
Provides post-implementation check out of system enhancements and thorough overview of enhancements to business owners.