• Sr Business Systems Analyst – Provider Network Pricing (Medicare Advantage)
About The Position
As a Senior Business Systems Analyst – Provider Network Pricing (Medicare Advantage), you will leverage your advanced expertise in both functional and technical areas for claims and provider pricing to drive impactful solutions across sophisticated systems and applications (i.e., Facets, NetworX, Optum). You’ll play a key role in shaping business strategies by defining, assessing, and validating requirements, and designing effective business and technical solutions for complex challenges within Provider Network Pricing. Acting as a vital liaison, you’ll represent your department, collaborating across teams to deliver innovative results while optimizing processes and reducing operational and system impacts. In partnership with IT and business, you’ll lead efforts to resolve issues, test new solutions, and coordinate software upgrades and high-profile projects, making a direct contribution to organizational success.
Requirements
- Bachelor's degree or advanced degree (where required)
- 5+ years of experience in related field
- In lieu of degree, 7+ years of experience in related field
- Intermediate expertise with Facets, NetworX, and Optum
- Strong PC skills with intermediate expertise with Microsoft Excel
- Intermediate CMS (Medicare) guidelines and rules knowledge
- Understanding of provider contractual terms regarding pricing
- Understanding of UB04 and HCFA1500 billing practices
- Strong interpersonal skills
Responsibilities
- Provide Network Pricing knowledge and support in system/application and procedural issues to the business and IT.
- Use judgment and initiative to review, analyze and develop solutions and applicable business processes for business systems while identifying and quantifying the business impact of those solutions to ensure quality, cost effectiveness, timeliness and customer service, including the resolution of large, complex production system problems.
- Provide systems (Facets, NetworX, Optum) analysis expertise and regularly consider the business implications of the application of technology to the current business environment
- Coordinate ongoing user support for ad hoc questions, inquiries, and service requests.
- Ensure efficiency of reporting and data tools for supported business area use and for trend analysis.
- Coordinate the development of system support processes with IT; coordinate daily to resolve production support issues, including application failures and user errors; document, track and report all system support activities
- Work collaboratively on projects and initiatives with the business and IT to test and implement long-term solutions by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used.
- Act as Business Lead/Coordinator on large, complex departmental and/or some corporate projects/initiatives.
- Facilitates project including intake, scheduling of projects, implementation, post-implementation support, and review and approve technical specifications
- Serve as point of contact for business testing activities and influence testing strategy to ensure testing will appropriately meet business requirements
- Analyze and verify results for accuracy, relevance and completeness.
- Provide impact assessments and make recommendations to the business owner regarding issues, risks, etc.
- Train/coach others on appropriate testing protocol, execution and test plan creation.
- Assist IT and help identify business area impacts for hardware and software upgrades, security changes, and architectural enhancements as needed.
- Configure and maintain critical system tables and data elements across multiple system environments
- Analyze, develop and implement configuration changes to improve system performance and user efficiency
Benefits
- Medical, dental, and vision coverage along with numerous health and wellness programs.
- Parental leave and support plus adoption and surrogacy assistance.
- Career development programs and tuition reimbursement for continued education.
- 401k match including an annual company contribution
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What This Job Offers
Job Type
Full-time
Career Level
Senior
