Senior Business Systems Analyst – Provider Network Pricing (Medicare Advantage)

Blue Cross NC is a health insurance provider, and they are seeking a Senior Business Systems Analyst to leverage expertise in claims and provider pricing. The role involves defining requirements, designing solutions, and collaborating across teams to optimize processes within Provider Network Pricing.

Responsibilities:

• Provide Network Pricing knowledge and support in system/application and procedural issues to the business and IT
• Use judgment and initiative to review, analyze and develop solutions and applicable business processes for business systems while identifying and quantifying the business impact of those solutions to ensure quality, cost effectiveness, timeliness and customer service, including the resolution of large, complex production system problems
• Provide systems (Facets, NetworX, Optum) analysis expertise and regularly consider the business implications of the application of technology to the current business environment
• Coordinate ongoing user support for ad hoc questions, inquiries, and service requests
• Ensure efficiency of reporting and data tools for supported business area use and for trend analysis
• Coordinate the development of system support processes with IT; coordinate daily to resolve production support issues, including application failures and user errors; document, track and report all system support activities
• Work collaboratively on projects and initiatives with the business and IT to test and implement long-term solutions by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used
• Act as Business Lead/Coordinator on large, complex departmental and/or some corporate projects/initiatives
• Facilitates project including intake, scheduling of projects, implementation, post-implementation support, and review and approve technical specifications
• Serve as point of contact for business testing activities and influence testing strategy to ensure testing will appropriately meet business requirements
• Analyze and verify results for accuracy, relevance and completeness. Provide impact assessments and make recommendations to the business owner regarding issues, risks, etc
• Train/coach others on appropriate testing protocol, execution and test plan creation
• Assist IT and help identify business area impacts for hardware and software upgrades, security changes, and architectural enhancements as needed
• Configure and maintain critical system tables and data elements across multiple system environments
• Analyze, develop and implement configuration changes to improve system performance and user efficiency

Requirements:

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field
• In lieu of degree, 7+ years of experience in related field
• Intermediate expertise with Facets, NetworX, and Optum
• Strong PC skills with intermediate expertise with Microsoft Excel
• Intermediate CMS (Medicare) guidelines and rules knowledge
• Understanding of provider contractual terms regarding pricing
• Understanding of UB04 and HCFA1500 billing practices
• Strong interpersonal skills