Business Analyst Mercycare Certified

3 weeks ago


Janesville, United States Mercy Health System Full time

JOB REQUIREMENTS: Overview Configures medical and pharmacy benefit packages, premium billing, finance, eligibility and customer service sub-system reference files using the managed care software provided by Epic. Designs, develops and maintains uniform and customized benefit packages for all insurance products, including HMO, PPO, POS, HSA, EPO, Medicaid and Medicare Supplement. Assists in operational planning to ensure interdepartmental accuracy of benefit interpretation and claims payment. Serves as project leader during system upgrades and implementation of new functionality. Serves as user support for the various business areas using the software, including enrollment, finance, claims, customer service, provider & fee schedule maintenance and marketing. Process jobs and reports related to Electronic Data Interchange (EDI) transactions. Perform technical system functions related to the transfer and retrieval of data files using standard IT protocols, such as FTP. This position may require occasional weekend work and flexible hours to meet project deadlines. Performs other duties as assigned. Responsibilities Essential Duties and Responsibilities * Develop and maintain expert level knowledge of Epic software, including claims, authorization, customer service, enrollment, provider reimbursement, finance and EDI modules, as well as detailed knowledge of workflow processes. * Business analyst suggests ways to maximize software applications to assist with process improvements and workflow changes. * Business analyst works on problems ranging from moderate to complex, in which analysis of the situation or data requires a detailed review of factors and issues, and coordination of efforts between programmers, vendors, system administrators and users. * Build and maintain benefit package configuration within Epic * Coordinate the loading of software fixes and upgrades, and perform tests to ensure seamless implementation of new functionality. * Create and maintain documentation to track testing and changes to software. * Coordinate user system security requests for all applications and systems used by MercyCare employees, and set up user security according to the most current security policy. * Import EDI claims and other transactions from various sender locations, and run jobs to process files into the appropriate module, on a daily basis. * Export EDI remittance advice files to appropriate provider trading partners. Configure and transmit EOB and EOP electronic files to vendor for mailing, using standard transmission protocols. * Develop and maintain expert knowledge of third party software and obtain required Epic certification(s) * Work with users to ensure Standard Operating Procedures (SOPs) accurately reflect system functionality and optimization. Culture of... For full info follow application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/05814B73F1F14F1F



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