Business Systems Analyst, Senior
Monterey Park, CA

Job Description

General Summary:

Sr. Business System Analyst will support manager on daily encounter data operation. To ensure (1) Encounter data submissions for all line of business (LOB) are in accordance with regulatory requirements and the contract previsions. (2) Business logics and system processes to be implemented accurately and timely. (3) Lead on various projects. (4) Optimize the solutions to support the department priorities.

Essential Functions and Key Responsibilities (in descending order of importance):

% of Time

Responsibility

30

Oversight daily encounter data operation. Monitor encounter processes from beginning to the end. Interpret regulatory agencies' business requirements; identify the opportunities to enhance & optimize the processes & performance. Provide solutions to trading partners on data errors & rejections.

20

Work with business users and IT department to effectively enhance internal data process and procedures. Gather & validate business requirements & translate them to functional requirements. Design Test Plan & Test Cases for QA/UAT & ensure all business requirements to be delivered accurately & timely.

20

Analyze encounter data submission volume, quality and timeliness. Trend submission to disclose any deficiencies. Provide Manager with causes and solutions.

15

Lead on various projects. Reconcile encounter end-to-end submissions, take the initiatives to develop methodology to monitor daily inbound & outbound submission performance.

15

Support all functions in encounter department to align with the department priorities and goals.

Education:

Bachelor's degree is required in computer science, healthcare management, data management, healthcare science, statistics, etc.

Master's degree is highly desired

Experience:

* Minimum of 5years related experience working in a managed care environment, preferably in a data analysis, operation management, and informatics position


* Minimum of 5 years prior experience with State and Federal regulatory data standards and requirements


* Ability to comprehend and work with HIPAA standard transaction sets, specifically 837P, 837I, 837D, NCPDP 4.2, 277, and 999


* Knowledge of healthcare management in Provider Network Operations, Member Enrollment, Claim Process, Medical Payment and Revenue Reporting, and Encounter submissions and measures


* Proficient in MS Access and Oracle database, SQL, and MS Office, SSRS, SSIS.


* Ability to conduct comprehensive data analyses, find the root causes of the rejections and issues, and interpret business requirements, data, and performance reports to identify the opportunities for the performance and process improvements


* Assist all aspects of the project management life cycle and software development life cycle (SDLD), including intake and manage operation related projects, business and functional requirements definition & collection, project effort documentation, QA, release management to production


* Ability to take the initiatives to develop methodologies, strategic plan to optimize the process and performance


* Ability to write analytical reports and comprehensive summaries


* Ability to effectively communicate with management and staff, as well as with external submitters


* Ability to prioritize and lead multiple projects concurrently


* Able to work in a fast paced environment with frequently changing work demands

CORPORATE COMPLIANCE:


* Understands and abides by all departmental policies and procedures as well as the organization's Standards of Conduct and Corporate Compliance Program.


* Attends mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class.


* Participates actively in ensuring that all state and federal rules and regulations are followed as they apply to this position.


* Abides by all applicable laws and regulations as mandated by state and federal laws and prevents being excluded or sanctioned from any state and/or federal programs as they pertain to healthcare.