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Business Systems Analyst II
1 month ago
We are seeking a highly skilled Business Systems Analyst II to join our team at Inland Empire Health Plan. As a key member of our team, you will be responsible for managing complex system configurations within our Business System.
Your primary functions will include accurate interpretation of state, federal, and contractual guidelines related to benefits, fee schedules, contracts, division of financial responsibility (DOFR), codification of services, and business requirements. You will translate these guidelines into configurable parameters within the Business Systems.
You will act as a subject matter expert for the business areas, helping to drive decisions related to system configuration. You will develop and maintain comprehensive documentation of business and technical specification requirements, utilizing best practice configuration guidelines developed by the Application Architects within the unit.
You will facilitate communication and formally report findings to various department heads and staff in a manner that is appropriate to the skill level and technical expertise of the audience. This position will be required to train and help educate other team members within the unit as necessary.
Key Responsibilities- Assist with the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation, and successful integration with internal and external systems and programs.
- Analyze and translate business specifications into detailed technical specifications based on system functionality and develop non-systematic workaround processes when necessary.
- Perform product system error root cause analysis.
- Track incoming requests and issue resolution through Microsoft Access, MediTrac, and Workfront tools.
- Identify and communicate the impact of system enhancements or configuration changes on integrated systems and processes.
- Monitor and work daily System Configuration inventory and ensure compliance with established service level agreements and regulatory timelines.
- Configure and maintain complex product-related system builds with multi-tiered functionality and interrelated system dependencies, including but not limited to Contracts, Benefits, Fee Schedules, and Service Categories.
- Assist the Contracting team with drafting appropriate contract fee schedule language to be in line with system adjudication capabilities and coding standards.
- Develop and maintain business requirements for the automation of coding updates.
- Track, test, and approve new system functionality, enhancements, and bug fixes, including the development and execution of test plans and scripts.
- Perform weekly/bi-weekly audit of check run products to proactively identify potential system configuration issues before products are released.
- Other duties as assigned, including but not limited to Department Projects and LEAN/A3 Events.
The IEHP Team is committed to incorporating IEHP's Quality Program goals, including but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
PerksIEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
- CalPERS retirement
- 457(b) option with a contribution match
- Generous paid time off - vacation, holidays, sick
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Paid life insurance for employees with additional options
- Short-term, and long-term disability options
- Pet care insurance
- Flexible Spending Account - Health Care/Childcare
- Wellness programs that promote a healthy work-life balance
- Career advancement opportunities and professional development
- Competitive salary with annual merit increase
- Team bonus opportunities
Four (4) years of experience with the development and remediation of moderately complex system configurations, including capitated provider agreement configurations. Bachelor's degree from an accredited institution required. In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position. Two (2) years of general healthcare experience plus two (2) years of configuration experience is required.
Key QualificationsKnowledge of Medicare and Medi-Cal fee schedules and benefit structure, and regulatory billing guidelines required. Knowledge of CMS, DHCS, DMHC, NCQA rules and regulations preferred. Extensive knowledge of CPT, HCPCS, Revenue, ICD10 coding rules and guidelines preferred. Extensive knowledge of general managed care operations required; delegated plan model preferred. Basic knowledge of relational database structure. Advanced knowledge of Product System algorithms and processes preferred. Familiar with basic medical product processing preferred.
