Business Systems Analyst III - Provider/Health Homes

Fidelis Care Rochester, NY 2017-01-25
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.

The Business Systems Analyst II , acts as a liaison between IT and operational departments within the organization. This position will primarily support the Provider functional area of the organization with responsibilities including but not limited to Health Homes, including the member health home assignment process, the generation of communications to members and Health Homes, billing and reconciliation of the monthly capitation process with NYS . This role will also support provider directory maintenance, provider contracting and credentialing. The role provides subject matter expertise and support to the clients in which it serves. The Business Systems Analyst II provides day-to-day production support of assigned organizational activities supported by IT. It also provides analysis and the development of business and functional requirements for initiatives of all sizes.

Ongoing monitoring of NYS health home regulations. Analyze and adjust current processes to meet changing NYS regulations.

Engage with Health Home personnel. Analysis and reconciliation of Health Home records.

Analyzes and queries data; has knowledge of the Facets data models. Queries data from MS Access and other data warehouse sources.

Provides day-to-day production support activities of the end-to-end health home process as noted above. Performs validation and balancing activities to ensure that accuracy and quality of all deliverables.

Data mapping, including the creation of file specifications; source to target mapping

Leads, supports 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, supports 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

Testing, including the creation of test scenarios, test data and understanding of outcomes

Mentors customers and peers

Communicates internally and externally with all levels of employees including upper management

Interacts with all areas of Information Technology as well as software vendors

End-to-end ownership of assigned initiatives – requirements through implementation

Keeps current with industry trends and state/federal compliance initiatives

Participates in user groups

Preferred Skills/Education:
BA/BS - Bachelor’s Degree or equivalent work experience required.

Minimum 3-5 years previous experience as a Business/Systems Analyst in a Health Care Industry

Previous experience with data analysis, balancing and reconciliation skills.

Experience with EDI X12 837 and 820 transactions

Experience with Provider data

Experience with Value Based Payment Program or Health homes or provider credentialing and contracting

Facets Data Model experience

Self-driven, self-learner, root cause and impact analysis experience

Experience working in a fast paced environment, ability to understand and shift priorities on a daily basis

Clear Communication skills

Ability to summarize information and help leadership with decisions

Proven problem solving and analytical skills

Detail oriented with the ability to manage multiple tasks simultaneously

Knowledge of Cactus data is preferred

Proficient with excel functions like VLOOKUP’s, pivots, etc.preferred

Proficient with Access DB preferred

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