Job DescriptionAccountable for ensuring Provider Pricing is accurately configured in the current Claims Platform. MUST HAVE HEALTH CLAIMS EXPERIENCE. Serves as a subject matter expert on reimbursement methodologies, provider contracting, including expert understanding of claims data elements for both CMS 1500 and UB claims. Serves as liaison between departmental teams to ensure end to end system set up is considered when necessary. Responds to ad hoc requests for support and analysis. Collaborates with functional teams, as well as with IT business analysts and programmers to develop best practice solutions. Must have the ability to translate business needs into business requirements and design best approach/solution. When needed can offer solutions on how to research using data, tools and comparing data.
- Develops and documents workflow, systems requirements, system impact analysis, systems design, process analysis and testing to provide efficient, cost-effective solutions. Identifies impact of solutions on existing and future systems. May perform operational activities.
- 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.
- Provides status reports that give a detailed description of the current projects 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.
In addition to expert knowledge in Pricing, Reimbursement Methodologies, and Claims, must also understands the business needs behind performance standards and develops plans to complete work accordingly. Takes quality into account as much as SLAs and TATs. Develops efficient processes to meet or exceed standards. Leads and participates in meetings and uses knowledge and experience to drive to desirable outcomes. Learns from past challenges and develops strategies to avoid similar errors in future tasks.
General Job Information
TitleBusiness Analyst II
Job FamilyGeneral Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date9/30/2019
Date Requisition Created9/26/2019
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
ResponsibilitiesRelated 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.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.