Sr. Business Systems Analyst

Job Description

Job Summary  

Under minimal supervision, this role leads projects and is responsible for supporting all aspects of IDX.

Ensure that all automated processes subscribe to the alerting and logging model appropriate to their category.

Adhere to policies around knowledge management, work management, change management and source control platforms.

Maintain or exceed SLAs for assigned work for quality, quantity, and communication measures.

Manage assigned escalations to resolution. Performs assigned duties to resolve any production issue as required.

Create documentation of work requested and work performed in both the work management system (ticketing/tracking) and knowledge management systems.

Use of CM (change management), KM (knowledge) and WM (work) systems in accordance with policy. 

Communicates in a timely and effective manner in both written and verbal forms with all project members internal and external to the organization.

Furnishes status reports to management staff on all projects in a timely manner. 

Works independently under specified assignments and objectives.

Applies judgment in devising logic and in selecting and adapting standard procedures.

Discuss or seek approval on difficult or complex matters with the appropriate management staff.

Work with PMS operational users and coordinate enhancements and upgrades with system vendors and IDX team members.

Provide problem solving, guidance and assistance to end-users.

Work with Athena, as necessary, for problem resolution.  This role is a primary contact for IDX, and is responsible for IDX communication within the organization, internal and external customers, and IT. 

Responsibilities

• perform this job successfully, an individual must be able to perform the job description satisfactorily. This job description reflects management's assignment of essential functions, it does not prescribe or restrict the tasks that may be assigned.  The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
  
  

Intermediate hands-on MS-SQL, able to create queries  

Expert knowledge of the claims data set (eligibility, benefits, contracts, fee schedules, authorizations, claims, NDC, CPT, ICD, UB Rev) 

Ability to build/modify/maintain Athena/IDX Financial Risk Manager application (FRM aka MCA) 

Basic understanding of claims EDI formats (X12) and of claims clearinghouse operation 

Intermediate understanding of claims payment data sets (EOBs and RAs) 

Gathering of business requirements and managing multiple projects 

Exceptional Managed Care experience with time on Claims and A/P

Knowledge of IDX Dictionaries, Forms/Screens, Rule Banks, DBMS, Cache/IRIS, SQL 

Excellent Verbal And Written Communication Skills Required

Results-driven, customer friendly, approachable and responsive

Able to deal with ambiguity and problem solve unassisted 

Excellent Self-management Skills And Organizational Skills Required. 

Experience with Eligibility, Authorizations, Claim and A/P

Knowledge of payment accuracy systems (Burgess, Cotiviti) a plus 

Individuals must be motivated, able to establish rapport and interact well with individuals on all levels of staff and leadership while maintaining a professional image and attitude .

Process oriented – adhere to standard work management processes and policies.  

Qualifications

Minimum Education:

Bachelor’s degree in information systems or equivalent experience.   

Minimum Experience:

Six (6) years of directly related operational, analytical and Core System experience as a Systems or Business Analyst in a Managed Care or Health Care environment. Athena (IDX) a plus, or other Healthcare Core Systems (EPIC, Facets, CSC, MC400, QNXT, EZCap etc.). Successful project involvement. Exposure to re-engineering and process improvement techniques.  Working knowledge of relational databases. Familiarity with SQL development a plus.

Preferred Education/Experience  

Bachelor’s Degree   

Experience in a Managed Care environment

Experience with Managed Care Applications or Healthcare Core system - (IDX, Epic, FACETS, NextGen)