Business System Analyst

Job Description

Perform analysis of medical payment rates and fee schedules.

Ensure fee schedules are loaded according to the provider contract, including audit of implemented.

Contracts.

Responsible for the identification, correction, and root cause analysis of fee schedule load and reimbursement problems.

Act as a subject matter expert on all reimbursement related questions, ensure the impact on fee schedules and reimbursement methodologies are implemented appropriately.

Serves as subject matter expert with all contract implementation for fee schedule, rate reimbursement matters, and payment methodologies.

Analyzes negotiated contracts to ensure that interaction with the core systems is aligned with negotiated intent.

Participate in rate testing with all impacted teams within the Plan.

Extensive knowledge in writing Business Requirements and Functional Requirement Documents

Minimum Qualifications

Bachelor’s degree in business, Finance, Economics, Information Systems or equivalent required.

Minimum 5 years of relevant experience, preferably in a health care environment.

Strong familiarity with health plan claims/provider billing systems and interdependent applications

Experience in data and auditing functions

Experience in developing and improving business process.

Knowledge of CMS, State Medicaid, and third-party fee schedules, as well as industry wide payment methodologies, and claims edit policies.

Excellent understanding of contracts, especially in a provider and payer relationship.

Ability to multi-task and perform in a fast-paced environment.

Ability to translate business process requirements into a production environment.

Proficiency in computer applications skills including Excel, Word, PowerBI, PowerPoint etc.

Knowledge of SQL/SAS, required