Senior Business Analyst - Encounter Operations

Preferred Qualifications - Encounters:

• Outbound Encounters Submissions; expert knowledge of X12 format to include 837, 999 and 277 files.
• Professional experience in the managed care, healthcare, Medicaid or other health insurance industries.
• Experience in Healthcare claims operations and/or encounter submissions preferred.
• Expertise in database management, data analysis, and process improvement.
• Proficiency in SQL and other database query languages.
• Requires strong expertise in MS Excel and other office products.
• Possesses strong analytical and problem solving skills, with experience working as a liaison between technical and non-technical groups.
• Excellent verbal and written communication skills while sharing complex healthcare analytic data.
• Ability to forge effective business relationships across organizations, functional groups and levels.
• EDIFECs experience preferred.

Serves as liaison between departmental team business owners, end users, IT, Claims and Clinical departments. Responds to ad hoc requests for support, reports and analysis. Supports departmental management team by providing trending and performance data. Supports special projects. Maintains and monitors reporting queues and requests (if appropriate), and internal share point sites. May participate in full life cycle development by performing requirements analysis, process development and design, and testing using development methodology. Collaborates with functional teams, as well as with IT business analysts and programmers to develop detailed design specifications according to standards.

• Develops and documents workflow, systems requirements, system impact analysis, systems design, process analysis and testing (including reasonableness checks) using software development methodology to provide efficient, cost-effective solutions as directed.
• Identifies impact of solutions on existing and future systems.  May perform operational activities.  
• Creates and maintains standard related reports to support operational and development needs.  
• Manages reporting and requests for ad hoc reports to support sales, implementation, new product development, specials.  
• Queries data warehouse and internal databases and prepares user friendly reports according to outlined requirements.  
• Creates and maintains internal management tools and databases to support CQI, rates, workflow business rules and system configuration, reimbursement and document management requirements.   
• Develops and maintains project plans.  
• Manages small to medium sized projects, system enhancements impacting data management.    
• Conducts root cause analyses, gathering data to pinpoint problem areas on which to focus, validating that the analysis is data driven, recommending and implementing solutions and evaluating those results, and implementing controls to monitor consistent use of the solution. 
• Participates in design plans for implementation, produces user documentation and training materials.  May conduct end user training.
• Provides status reports that give a detailed description of the current project?s progress and indicates time devoted to each task of the project; leads status meetings, creating agendas and documenting meeting minutes as needed.
• Identifies reporting needs based on system configuration and workflows and documents reporting requirements and testing of new reports in development prior to implementation to Production.
• Participates in initiatives or projects that support process improvements, leveraging new system capabilities or the integration of data/other applications into existing systems.
• Performs other duties as assigned.

Other Job Requirements

Responsibilities

5+ years of experience in analysis.
Related professional experience in the managed care, healthcare, or insurance industries.
Analytical/problem solving skills, excellent verbal and written communication skills, strong PC background, efficient in using standard software.
Knowledge of system process analysis and/or program management, estimating IT system development and testing.
For positions supporting Medicare, requires 3+ years of experience working in Medicare Operations.

General Job Information

Title

Senior Business Analyst - Encounter Operations

Grade

26

Work Experience - Required

Business Analysis

Work Experience - Preferred

Education - Required

A Combination of Education and Work Experience May Be Consi