Job Description

Perform technology 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. Design, create and implement technical solutions. Support complex business processes.

• 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 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.
• 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.
• 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.
• 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.

QUALIFICATIONS

• Bachelor’s degree in related field preferred.
• Three (3) 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, and 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 Preferences:

• Expert knowledge of Payment Integrity is preferred.
• Knowledge of SQL 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 and Facets 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 NCCI billing standards, and CMS mandates is preferred.