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Sr. Business Analyst - Claims / RCM Operations

Sr. Business Analyst - Claims / RCM Operations

Job ID 
2017-4421
Job Locations 
US-Remote
US-Remote
Category 
Billing & Collections

More information about this job

Overview

The Sr. Business Analyst will support the Revenue Cycle Management (RCM) department with new client and vendor implementations, and identifying opportunities for system and or process improvements. Participates in documentation of detailed business and system requirements, data analysis and User Acceptance Testing. Participates in the development of test scripts, executes test plans and defect resolution. Serves as a liaison between business owners, end users, and IT partners ensuring cohesive approach, comprehensive solutioning, and excellence in delivery. Responds to ad hoc requests for support and analysis. 

 

This position is critical to improving the overall claims reconciliation processes and system effectiveness and will have a role in system enhancements, working closely with the operational leads to ensure a smooth transition. Responsible for the monthly releases to ensure there will be no impact to claims. 

Responsibilities

  • Gain a thorough understanding of how our claims system functions including where we can easily configure changes and where we need to modify the system code to implement new clients.
  • Create system change requests (CR) as needed to outline new system functionality required to support a new client.
  • Support official change management initiative (CMI) processes including the creation of Business Requirement Documents (BRD), RCM sub-team charters, project plans, SIPOC-R diagrams and RACI diagrams.
  • Monitor operational key performance indicators to identify root cause of poor performing metrics and make recommendations for improvement.
  • Oversee cross-functional processes, ensuring that other departments are following defined processes in a timely manner.
  • Partner with external departments to find the root cause of claims with adverse financial outcomes, then work to ensure a remediation plan is put into place.
  • Understand and become knowledgeable in Health Plan, Provider and Vendor contracts. 
  • Prepare PowerPoint presentations for senior and executive leadership.
  • Attend meetings and provide project updates on behalf of the RCM.
  • Perform operational readiness testing (ORT) as needed once client configuration is created by the business technology team.

Qualifications

  • Bachelor’s Degree in Business or Management, or experience in the field may substitute some educational requirements.
  • 3-5 years of related experience in working in the health insurance industry
  • 3 years of experience gathering business requirements and user acceptance testing.
  • 2+ years experience in Medical Claims preferred.
  • Required technical skillset(s): Excel, Project and PowerPoint
  • SQL, Tableau and MS Visio preferred

 

 

CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.