Business Systems Analyst III - QHCM

Fidelis Care Rochester, NY 2017-02-20
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 acts as the primary liaison between IT and the operational departments within the organization. This position functions in a trusted advisor role and 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. This individual also serves in a relationship management role to increase customer service, and participates on project teams to assist in timely delivery of IT project initiatives. This position will primarily support the Quality Health Care Management area of the organization including Utilization Management, Care Management, Managed Long Term Care, Behavioral Health and Pharmacy.

  • Serves as technical and process expert for initiatives involving Quality Health Care Management
  • Leads and guides workgroups through the evaluation of current state processes. Performs analysis to define opportunities to create improved future state processes (end-to-end process flow development)
  • Conducts analysis of business and user's needs and forecasted outcomes to achieve system redesign process alternatives
  • Assists management and end users in evaluating vendor software applications.
  • Partners with functional leads to ensure consistency, coordination, and integration of design activity within functions (e.g., UM, case management, disease management, pharmacy, IT.) that support the strategic goals of Quality Health Care Management
  • Leads and facilitates requirements and design sessions to identify specifications for system changes
  • 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 inclusive of successes, barriers, and identified challenges
  • 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
  • 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
Required Skills/Experience:
  • 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 Medicare, Medicaid, Commercial, FIDA, HARP and Managed Long Term Care programs
  • Previous experience with utilization management, care management systems and operational workflows. Experience with TriZetto Facets Utilization Management system and Clinical Care Advance applications a plus
  • 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
  • Proven problem solving and analytical skills

To learn more about our Mission and growing company, please visit