Job Description: Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function.

Education/Experience:
Bachelor s degree in related field or equivalent experience. 4-6 years of business process or data analysis experience, preferably in healthcare. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Project management experience preferred.

Benefits and Payment Configuration:
Bachelor s degree in related field or equivalent experience. 4+ years of business process analysis, preferably in healthcare (i.e. documenting business process, gathering requirements) or claims payment/analysis experience. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. Knowledge of managed care information or claims payment systems preferred. Previous structured testing experience preferred.

Compliance Coding/Prepay Compliance (Payment Integrity)
Bachelor s degree in related field or equivalent experience. 4+ years of business process analysis (i.e. i.e. documenting business process, gathering requirements). Experience in healthcare industry, preferably with managed care techniques and administrative philosophy. Experience in claims coding analysis or medical claim review/research preferred. Knowledge of Amisys claims payment system and Business Objects preferred.

Encounters:
Bachelor s degree in related field or equivalent experience. 4+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry or 3+ years of managed care encounters experience. Advanced knowledge of Microsoft Applications, including Excel and Access preferred. Experience with encounters or claims business analysis experience in healthcare, preferably managed care or Medicaid. Knowledge of Amisys or other claims system, HIPAA transactions (i.e. 837, 999, 824, 277) and SQL Scripting preferred.

Medicare
Bachelor s degree in related field or equivalent experience. 4+ years of business process analysis (i.e. documenting business process, gathering requirements). Experience in healthcare industry, preferably with managed care techniques and administrative philosophy. Experience in managed health care experience, preferably with Medicare. Experience working with and leading diverse teams in matrix managed environments. Advanced knowledge of Microsoft applications, including Excel and Access preferred. Project management experience preferred.

Provider Data:
Bachelor s degree in related field or equivalent experience. 4+ years of business process analysis (documenting business process, gathering requirements) experience in healthcare industry and/or working in a data driven environment. Advanced knowledge of Microsoft Applications, including Excel, Project, and Visio preferred. Knowledge of data migration, software enhancement/planning, and Agile preferred. Experience managing projects with a high reliance on technology.

Member & Provider Solutions
Bachelor s degree in related field or equivalent experience. 4+ years of business process analysis (i.e. documenting business process, gathering requirements) experience in healthcare industry and/or customer service or enrollment functions. Advanced knowledge of Microsoft Applications, including Excel and Visio preferred. Experience managing projects with a high reliance on technology. Knowledge of data integration, software enhancements/planning and Agile preferred.

Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
Identify and analyze user requirements, procedures, and problems to improve existing processes
Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations
Identify ways to enhance performance management and operational reports related to new business implementation processes
Coordinate with various business units and departments in the development and delivery of training programs
Develop, share, and incorporate organizational best practices into business applications
Diagnose problems and identify opportunities for process redesign and improvement
Formulate and update departmental policies and procedures
Serve as the subject matter expert on the assigned function product to ensure operational performance.
Ability to travel
Additional Sills: