Business Systems Analyst III - Vendor Oversight

Fidelis Care Rochester, NY 2017-03-16
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. It provides subject matter expertise to the clients in whom it serves through analysis and the development of functional/technical 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 timely delivery of IT project initiatives. This role also serves as a mentor to team members. This position will primarily support the Vendor Oversight area, which requires engagement with external entities that support Fidelis for Pharmacy, Dental and Vision services.

Provide functional support for the exchange of organizational data between Fidelis and its delegated vendor partners – including but not limited to eligibility, claim and invoicing data

Subject matter expert level knowledge of the specification documents for all inbound and outbound files.Ability to interpret organizational changes and turn them into functional/technical requirements for development staff.

Implementation of balancing and controls for files in and out of the organization

Understanding of data models and relational table structures involving medical, prescription drug, vision and dental claims data.

Understanding of health plan data acrossmultiple business domains and lines of business

Engage with external regulatory agencies to participate in audits and reviews of vendor related data

Provide data analysis leadership on complex data analysis initiatives to meet business analytic and regulatory reporting needs

Adhoc query writing with time sensitive target dates involving complex data relationships and large amounts of data. Analyze result sets and data universes to arrive at accurate conclusions and summarize findings. Uses metrics and data to lead process improvement initiatives

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

Lead and guide workgroups through the evaluation of current state processes.Performs analysis to define opportunities to createimproved future state workflows/solutions (end-to-end process flow development)

Leads and facilitates requirements and design sessions. Documents business and functional specifications used for software design and development.Conducts requirements reviews to obtain sign-off from project/operational stakeholders.

Identifies issues and facilitates problem resolution.

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

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

Required Skills/Experience:
BA/BS – Bachelors’ Degree or equivalent required.Degree in Computer Science or Computer Programming a plus

Minimum 5-8 years’ experience as a Business/Systems Analystin Health Care Industry experience

Strong data analytics and SQL query skills

Previous experience in IT vendor management including functional responsibility for the content and quality of files that flow in and out of an organization

Understanding of health plan data acrossmultiple business domains (eligibility, claims, provider data) and lines of business (Medicare, Medicaid, ACA)

Previous experience with TriZetto Facets applications preferred

Proven problem solving and analytical skills, ownership of work, and ability to work independently under pressure to create quality time sensitive deliverables

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

Excellent interpersonal, written and verbal communication skills

Ability to build and maintain good rapport with internal and external customers and handle situations with confidence, tact and resourcefulness

Excellent PC skills utilizing Microsoft Office software(Excel, Word, Visio, PowerPoint, and Access)

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