Perform functions to include but not limited to business and systems analysis, application development and process improvement. Serve as a liaison between the business area and the IT organization when needed. Identify, document and communicate system and process changes necessary to improve system and operational performance measures. Possess an in-depth knowledge of line of business while contributing to the identification, analysis and recommendation of technical process improvement initiatives. Support highly complex business processes requiring design or integration of technical solutions that may cross multiple functions of the business. Design, create and implement technical solutions. Serve as a lead role.
Business Analysis
Conduct data gathering and analysis to understand business strategy requirements. Provide direction for short and long-term planning sessions and provide direction to ensure understanding of business goals and direction.
Evaluate ongoing department activity and propose new tools or technologies.
Application Development
Assist in the business process redesign and documentation as needed for new technology. Assist in the application development process for multiple applications to ensure application software is delivered on time and within budget. Ensure all system development lifecycle processes and standards are followed.
Design, code, test, debug, document, implement and maintain complex business applications. Provide ongoing maintenance of applications.
Provide analytical support related to business applications, infrastructure and technology related activities.
Systems Analysis
May serve as subject matter expert related to interface problem identification, triage and resolution of complex inquiries. Discuss users' needs and determine vulnerabilities or areas of poor performance to boost productivity, efficiency and accuracy in our computer systems. Develop system solutions by preparing and evaluating alternative workflow solutions.
Perform release management and end to end testing of system changes.
Identify, investigate, resolve and escalate problems a needed. Gather data to support recommendations to address problems. Procure additional technical assistance to help in problem resolution.
Process Improvements
Work as a team member or lead on medium or large process complex improvement initiatives supporting the business customer(s)/services(s).
Analyze and evaluate business requirements and current processes and interfaces to identify gaps and areas of improvement.
Develop process requirements and recommendations and communicate for the implementation of technical business solutions.
Other Duties and Responsibilities
Design and develop reports and data delivery to accommodate changing business requirements. Investigate, resolve and escalate problems.
Adhere to policies and procedures supporting audits to ensure compliance with regulatory requirements.
Train and educate users on new and existing tools. Coach and transfer knowledge to less experienced team members.
Other duties may be assigned.
"Qualifications"
Bachelor's degree in related field preferred.
Five (5) years of relevant technical or business work experience required.
Experience in managing cross functional teams or projects required.
Advanced knowledge preferred in :
system development life cycle
process design, re-engineering, and organization transformation, Six Sigma, CMMI or ITIL
computer programming languages
Basic knowledge of business operations and systems requirement processes.
Strong technical, analytical, systems skills.
Display innovation in identifying, proposing, and overseeing the execution of business solutions.
Written and verbal communication skills interpersonal skills.
Ability to provide technical or business guidance to clients, both internal and external.
Ability to work independently, or within a team environment.
Other related skills and/or abilities may be required to perform this job.
Departmental Duties and Responsibilities:
Partner with MDSS, Architecture, Inter-Plan Admin & Relations, Legal, EDI, Compliance and key business areas to provide pre-project consultation and solution development.
Build cross-functional partnerships with MDSS, Architecture, Enterprise Business Readiness, Business Segments, Operational Business areas, BCBSA, Blue Plans and other corporate areas to ensure compliance with Association, Federal and State Guidelines in project designs or changes to the guidelines themselves.
Provide solutions to complex problems and make recommendations to resolve (improve strategic initiatives and technical processes).
Act as an internal PIU consultant to corporate areas as needed. Ensures that programs/ projects with changes to many system applications, data flow and interfaces, data configuration, products, provider networks and business processes that are utilized throughout the organization are designed with an 'end to end' perspective.
Provide input and design operational capabilities required to support enterprise objectives and segment-specific business strategies.
Support operational capability execution through delivery lifecycle to ensure implementation activities remain aligned to target design.
development of business cases to secure funding to enhance systems or resolve an issue.
Coach and mentor individuals on project teams and to provide a model for implementing or improving end to end knowledge.
Working independently within guidelines, responsible for initiating, planning, executing, controlling, and closing application and system implementation projects using a formal project management methodology.
Represent Payment Integrity on corporate projects as needed.
Present payment policy opportunities to executives.
Departmental Qualifications:
Expert knowledge of InterPlan Policy and National Programs Payment Integrity is preferred.
Strong ability to manage and analyze data in multiple environments using a variety of scripts, potentially including but not limited to SQL, Alation, InterPlan Data Solutions, Cognos is preferred.
Knowledge and experience of conducting corporate and InterPlan audit reviews to ensure data and financial accuracy is preferred.
Knowledge of clinical editing systems and concepts is preferred.
Familiarity with claims processing and payment policy on NASCO, Facets and Ika is preferred.
Demonstrates extensive and broad base knowledge of NASCO claims end to end from a system and business perspective is preferred.
Expert knowledge of BlueCard policies, procedures and system design is preferred.
Experience with review and providing input to testing strategies, test scenarios, regression testing, execution, validation, and approval is preferred.
Experience with implementation of ITS Releases, NCCI billing standards, and CMS mandates is preferred.
Demonstrated ability to ensure compliance to Association, Federal and State Guidelines are met in project designs or changes to the guidelines themselves is preferred.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
