Senior Business System Analyst
About The Position
About HealthEdge HealthEdge® is trusted to provide the technology and services that power health plans’ most important value streams. With an integrated platform of solutions spanning claims administration, quality improvement, prospective payment accuracy, provider network management, care management, member engagement and risk adjustment, HealthEdge enables health plans to converge their data so they can harness automation and the promise of AI. Combining this next-gen technology with services and expertise gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences. For more information, visit www.HealthEdge.com. Position Overview: We are searching for a highly skilled and experienced Senior Business System Analyst to join our growing team. The Senior Business System Analyst (BSA) will help in capturing the business requirements to run the Health plan customer’s Core admin business functions while implementing UST HealthProof’s core-admin ecosystem. The BSA will work with the Health Plan Customers, third party vendors/partners, Internal product teams, solution architects and product owners to define the business rules and processes required for implementation You should possess deep knowledge & experience in HealthCare Payor domains (Claims adjudication, Enrollment, Provider, Payment). You should have excellent requirement elicitation and communication skills and ability to engage as part of a team working both physically and virtually. Also, you should be able to identify the customer problems and work with Solution Architect(s) to provide the solution to customer.
Requirements
- Bachelor’s degree or higher in business or technical field
- 12+ years of relevant work experience in business analysis
- Knowledgeable in Healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA or Commercial)
- Exposure to healthcare eco-systems from partners like HealthEdge, TriZetto , NASCO, Advantasure or Change Healthcare
- Experience with mapping of EDI healthcare transactions (837, 834, 835,270/271, 276/277, 278)
- Experience in analysing the business requirements and translating/mapping them to technical requirements in EDI technology by analysing implementation/companion/TR3 guides
- Experience documenting requirements or user stories and communicating the requirements to technical teams, partners/vendors or product teams Experience working in an onshore/offshore model is a must
- Communication skills with peers, customers, and partners including the ability to convey information effectively
Nice To Haves
- Experience working HealthEdge applications like HealthRules Payor or GuidingCare is a plus
- Understanding of SQL, XSDs is a plus
- Awareness to Agile tools and scrum methodologies
Responsibilities
- Leading business requirement conversations with customer and internal teams.
- Managing the end-to-end requirements involving all the stakeholders.
- Responsible for developing business and functional requirements for Claims, Enrollment, Provider, Authorization, Payment systems.
- Create solutions for current business processes using UST HealthProof’s core-admin ecosystem.
- Negotiate with client to develop processes that are current and applicable to the situation.
- Collaborate with business users, management, IT, and offshore staff to ensure the finish product meets project objectives and client expectations by applying ‘Agile like’ project methodology.
- Instrumental in analyzing the healthcare business requirements and translating them to functional and technical requirements.
- Identify opportunities for automation, performance improvements, reusability.
- Develop high level workflow diagrams and system context diagrams.
- Document the understanding of the process flow using swim lanes diagrams.
- Produce the Requirements plan that aligns with the overall Project Implementation plan.
- Dictate the risks and dependencies in the timely manner with the Customer to complete the requirement gathering to meet up with the project plan dates.
- Must work with Offshore Business Analysts to elaborate user stories.
- Conduct Requirement walk through with the customer and internal/external stakeholders.
- Collaborate with the development team & QA team to ensure the finish product meets project objectives and client expectations.
- Contribute towards sprint planning, retrospective, go-live/no go-live evaluation meetings.
- Conduct Demo of MVPs for the customer.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
