Principal Business Systems Analyst Claims EDI

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Principal Business Systems Analyst – Claims EDI is responsible for solving cross-functional organizational information problems through identification and presentation of business and technical specifications based on customer and business needs, industry best practices and available technology. The incumbent for this role will work across the organization to define the functional, usability, reliability, performance and support requirements of a system, serving as a business subject matter expert for EDI Healthcare Claims and Electronic Remittance Advice (837/835), providing a link between the technical and business views of the system to ensure the solutions being developed will satisfy the needs of the business.

Amount of Travel Required: 5-10 %

Work Schedule: Travel; with Program Manager, Medicare D-SNP Enrollment work protracted and irregular hours and evening meetings, or work unusual hours for meeting attendance or participation in specific projects or programs.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statements

The following duties are expected to be performed for both the Medicare, Medicaid and any new business units:

•    Responsible for Claims, Claim Payments and EOP Domain 

•    Partners with operational claims and claims payment SME’s to translate business requirements into technical requirements

•    Responsible for creation and maintenance of companion guides

•    Participate in new or existing projects to implement new or modified EDI capabilities 

•    Responsible for identifying impacts to EDI

•    Responsible for drafting the EDI Business and Technical Project Requirements

•    Responsible for EDI Operational Readiness and contributing into Project level operational readiness

•    Contributes to test planning and test case generation

•    Monitors Project level SDLC to ensure that coding changes are tested and then promoted to production

•    Maintain EDI documentation

•    Share EDI documentation with relevant parties

•    Participates in business discussions to act as SMEs

•    Monitor, track and understand state and federal regulatory impacts to EDI and the 837I, P, D, and 835 transaction sets

•    Assists troubleshooting L2 support requests

•    Provides analytical support for systems projects, including business function support for large, complex, enterprise-wide transformation initiatives, data and system migrations, business area process transformations or improvement projects, and product installations.

•    Consults with business to identify and document current operational procedures, problems, system input and output requirements, data scope, functional usage, formatting, user screen layout design, workflows and security requirements.

•    Leads system requirements, user