Business Systems Analyst III - Compliance & Audit

Fidelis Care Rochester, NY 2016-11-10
Fidelis Care offers quality, affordable coverage to residents across the State of New York, including products available through Medicaid, Medicare and the NY State of Health. Fidelis Care was founded on the belief that all New Yorkers should have access to affordable, quality health insurance and that remains our mission to this day to our 1.5 million members.

Position Summary

The Business Systems Analyst III – Compliance/Audit has a strong emphasis on data analysis, and the ability to traverse complex data models to extract and assemble data that meets regulatory requirements. Strong SQL and data analysis skills are required along with the ability to perform process analysis and re-engineering.

Key Responsibilities
  • Reviews audit and compliance related communications. Interprets, clarifies and confirms understanding of regulatory requirements.
  • Drives understanding of requirements across cross-functional teams comprised of both information technology and organizational business owners
  • Analyzes and queries data; has knowledge of the Facets data models. Queries data from data warehouse sources.
  • Data mapping, including the creation and maintenance of file specifications; source to target mapping
  • Participates in regulatory meetings and webinars to obtain regulatory requirements and direction
  • Leads and guides workgroups through the evaluation of current state processes. Performs analysis to define opportunities to create improved future state workflows/solutions (end-to-end process flow development)
  • Leads and facilitates requirements and design sessions. Documents business and functional/technical specifications used for software design and development including software traceability matrices and use case diagrams.
Position Qualifications
  • 5+ years experience as a Business Systems Analyst

  • Healthcare industry experience.

  • Strong data analytics and SQL skills.

  • Previous experience and business knowledge with healthcare claims systems, medical management and the appeals and grievance processes.

  • Knowledge of health care benefits and product offerings including Medicare, FIDA and Medicaid preferred.

  • Experience with CMS Part C and D reporting, Data Validation Audits, CMS ODAG/CDAG Audits, and NYS Article 44 audits a plus
  • Previous experience with TriZetto Facets applications preferred.
  • BA/BS – Bachelors Degree or equivalent required.
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