Application Systems Analyst I
Irving, TX

Job Description

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare-now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for the Application Systems Analyst I who will be a point of contact for the IT applications development team and Production teams for the creation of carrier eligibility applications. The analyst would create, update, and maintain said carrier applications and facilitate movement and processing of electronic data between external and internal platforms. The analyst would also be asked to assist with quality control review of the applications and manually process any records that fail the application adjudication.

Essential Responsibilities:

* Partner with internal departments to create, format, and update application workflow requirements for EDI X12 270/271 Eligibility and Benefit transactions.
* Liaison with the IT application team to create carrier eligibility applications to exchange data with outside trading partners for cost avoidance verifications.
* Responsible for application production release, as well as analysis, testing, and maintenance of the application through its lifecycle.
* Establishes and maintains relationships with commercial insurance EDI trading partners, including assisting in resolution of connection issues.
* Analyzes data trends between EDI, web application, and phone verifications for optimal data mapping.
* Reviews verification results with a focus on maximizing yield of deliverables to clients.
* Participate in business design meetings.
* Perform manual review of records that didn't pass first pass adjudication.
* Assist with manually completing records to meet business goals.
* Assist with maintaining and updating standard operating procedures.
* Complete Root Cause Analysis of issues/enhancements with apps and update requirements documentation.
* Liaison with the other internal production teams to troubleshoot production issues and provide assistance and training on application workflows.

Non-Essential Responsibilities:

* Performs other functions as assigned

Knowledge, Skills and Abilities:

* Ability to write and read queries that join to different tables. Complexity rages from easy (basic select query) to moderate (more complex that joins on different tables, aggregates number, uses case states and built in functions) in difficulty.
* Knowledge on how databases are linked, how to link them, and how data moves through the systems
* Knowledge on creating excel pivots and charts, and excel formulas, creating power point presentations
* Not just identifying an issue but being able to dig into it to find the true root cause ('5 Why' analysis)
* Ability to look at processes & problems beyond the obvious, perform analysis, and make informed suggestions to leadership on how to overcome problems, or make processes better
* Experience in working in a SCRUM/Agile environment and partnering with a Dev team
* Ability to write user acceptance test cases, perform/complete the testing and adjust test cases to complete new function testing and regression testing.
* Write technical specs for developers and create standard operation procedures for existing and new processes. Ability to logically create the steps a human would complete to ensure the machine perform the same way. Includes understanding of and skills in testing the negative ("what if the password is invalid", "what if the page doesn't load")
* Using conventional and outside-the-box thinking to solve the problems rather than escalating the problem to superior
* Ability to self-start tasks, work towards departmental goals with minimal work direction given.
* Ability to communicate (written and verbal) with various levels of the organization across different locations and including various off shore groups. This includes but is not limited to creating summaries, reports, procedures, and decks.
* Knowledge of the x12 5010 standard. Prefer knowledge in 27x transactions
* Experience in healthcare industry
* Experience in healthcare eligibility knowledge (checking eligibility, using different clearinghouses or web portals to check coverage)
* Ability to work with different levels of the organization, different departments, teams, and off shore.
* Ability to contribute to design meeting and look at the larger picture and how current task/product fits into the larger picture. Ability to see how current task/product interacts with larger picture.
* Ability to complete repetitive tasks that a machine would do to test and simulate its works.
* Ability to create statistical process controls to ensure applications and processes perform within desired tolerance. Create and set tolerances for applications and processes and to ensure applications and processes and within guidelines
* Ability to create process flows/swim lanes to map
* Ability to work on multiple tasks/projects assigned at once and to manage and ensure all tasks completed on time

Work Conditions and Physical Demands:

* Primarily sedentary work in a general office environment
* Ability to communicate and exchange information
* Ability to comprehend and interpret documents and data
* Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
* Requires manual dexterity to use computer, telephone and peripherals
* May be required to work extended hours for special business needs
* May be required to travel at least 10% of time based on business needs

Minimum Education:

* The knowledge typically acquired during the course of attaining High School diploma is required. A combination of education and experience may be used in lieu of a diploma. Associate's degree preferred or prior work experience in health insurance, EDI, or information systems

Minimum Related Work Experience:

* >1 year work experience within health insurance/IT/EDI market
* Familiarity with relational databases and SQL
* Proficiency in Microsoft Office applications
* Familiarity with X12 and/or XML standard formatting languages
* Proficiency in logical process mapping
* Familiarity with Root Cause Analysis
* Familiarity with IT development life cycle (SCRUM/Agile) methodologies

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

EOE including disability/veteran