Business Systems Analyst III (Medicare)

Fidelis Care Rochester, NY 2016-11-09
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 (BSA III) acts as the primary liaison between IT and the operational departments within the organization. This position functions in a trusted advisor role. The BA III provides subject matter expertise to the clients in which it serves through analysis and the development of business and functional requirements for initiatives of all sizes. The Business Systems Analyst III serves in a relationship management role to increase customer service, and participates on project teams to assist in the scoping and timely delivery of IT projects. This role also serves as a mentor to team members.

This position will primarily support the Medicare Program within the Fidelis organization including but not limited to IT request management and assignment, day-to-day support activities, production issue management and resolution, maintenance, discretionary and strategic initiatives, and annual recurring projects such as CMS Audits, Data Validation Audit, Medicare Risk Medical Records sweep, Annual Medicare Benefits changes and CMS Open Enrollment enhancements including reporting, ANOC, EOC, and Low Income Subsidy Acumen Match Rate reporting.

Key Responsibilities
  • Serves as technical and subject matter expert for initiatives involving the Medicare line of business.
  • 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)
  • Assists management and end users in evaluating vendor software applications.
  • Leads and facilitates requirements and design sessions. Documents business and functional specifications used for software design and development including software traceability matrices and use case diagrams.
  • Conducts requirements reviews to obtain sign-off from project/operational stakeholders.
  • Sets projects timelines with identified deliverables. Creates task lists/project plans for smaller initiatives. On larger project initiatives completes assignments as defined by the Project Team.
  • Reports project status updates to stakeholders
  • Identifies issues and facilitates problem resolution for manual, batch and online environments. Ability to interrogate error codes
  • Uses metrics and data to lead process improvement initiatives
  • Analyzes and queries data; has knowledge of the Facets data models
  • Data mapping, including the creation of file specifications; source to target mapping
  • Testing, including the creation of test scenarios, test data and understanding of outcomes
  • End-to-end ownership of assigned initiatives – requirements through implementation
  • Keeps current with industry trends and state/federal compliance initiatives
  • Participates in user groups
Position Qualifications
  • BA/BS - Bachelors Degree or equivalent required. Degree in Computer Science or Computer Programming a plus
  • Minimum 5-8 years previous experience as a Business/Systems Analyst
  • Health Care Industry experience
  • Knowledge of health care benefits and product offerings including Medicare, Dual, FIDA and SNP programs
  • Previous experience with TriZetto Facets applications preferred including EAM – Enrollment Administration Manager.
  • Proficiency with SQL (querying, analyzing and mapping data)
  • Demonstrated ability to ..
  • Lead and elicit business needs and requirements from a diverse set of stakeholders
  • Document and communicate requirements to the stakeholders, developers and testers.
  • Construct or modify use case diagrams and process models.
  • Create and execute test scenarios
  • Experienced in full software development life cycle
  • Understanding of the concept of online and batch environments
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