Operations Business Analyst I

Operations Business Analyst I

Job ID 2013-24087 # Positions 1
Location US-FL-Tampa
Search Category Information Technology
Type Regular Full-Time (30+ hours) Posted Date 9/6/2013
Additional Locations ..

More information about this job:
Summary:

*Must have general claims knowledge*

Performs general research and analysis to support business operations. Determines best practices and suggests how to improve current practices. Assists in the development of recommendations to solve problems and issues related to business operations. Prepare presentations to report findings to a functional or project leadership. Gathers basic business requirements, performs first level analysis, supporting the development and testing processes of assigned functional areas.

Responsibilities:

Perform requirements gathering, analysis, and process and data flow diagramming for simple processes of low complexity.

1. Make recommendations for the Resolution of basic design and functional area organizational issues utilizing department resources, business development lifecycle and development methods and software applications.

2. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, and logical flow charts.

3. Evaluate and test basic new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Coordinate problem resolution with other departments or vendors.

4. Assist in the development of functional test plans used to verify specific system functions according to actual requirements and established guidelines.

5. Read and interpret a business policies and design documents.

6. Develop and run simple queries and reports for business analysis and trends.

7. Performs other duties as assigned.

Qualifications:

EDUCATION AND EXPERIENCE

Education

Required:
- Bachelor's degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience in a Business Analyst role is acceptable in lieu of a degree(s).

Years and Type of Experience Required:

Required:
- Experience in financial, functional analysis, or business analysis.
- Health Care industry experience.

Certifications or Licensures

Preferred:
- CCBA certification (Certification of Competency in Business Analysis)

Language Skills

Required:
- English

TECHNICAL COMPETENCIES
- Demonstrate a basic understanding of core applications and systems.
- Demonstrate proficiency with all applicable company supported software applications: QUEST is crucial to this role
- Able to provide professional and appropriate written information to internal and external customers.
- Able to initiate conceptual ideas with practical applications.
- Basic knowledge of the inter-relationship among various managed care operational areas.
- Basic knowledge of current technology trends.
- Able to develop and maintain customer relationships.
- Able to identify, analyze, and solve problems and to work with teams to solve problems.
- Able to develop and implement basic project plans.

Computer Skills and Office Equipment - Basic
- Computer skills refer to ability to use software and hardware of a computer to complete certain simple tasks. Skills to use basic office equipment such as telephone, fax machine and copy machine. Working knowledge in a windows environment to include navigation skills using a mouse and keyboard. Use of internet. Ability to review and draft correspondence in email system and word processing systems. Ability to use spreadsheets to review, organize and edit data.

Spreadsheet Utilization and Management - Intermediate
- Proficient in use of spreadsheet applications such as Excel including ability to use large data sets, filters to find specific data in a large list and calculation tools.

Database Utilization and Database Management
- Novice level.

Systems - Basic
- Understanding of system's utilization and basic retrieval of information and processing of the following systems:
- NetworX/Facets
- MACESS - contracts and claim images are stored. MACESS Workflow tool for contract life-cycle.
- Software products from Ingenix for prospective payment system (PPS) - pricing.
- Clearquest is used to track projects -knowledge and familiarity using a project inventory tracking system.

Applications/Tools - Basic
- Is aware and knowledgeable of tools and templates and is learning to use them on the job. Tools such as: TOAD, UltraEdit, Microsoft Project, Microsoft query analyzer SQL mgr, VISIO, (Google), Internet Search, Internet research, use and understand generally accepted templates and BA tools. Powerpoint. SDLC (software development life-cycle), TeamTrack, SharePoint, Ability to go through CNR (change notification request) process.

Industry Knowledge & Familiarity - Basic
- General healthcare, who are our providers (hospitals phy ofc, ancil) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works.
- More specific knowledge around reimbursement methodology, fee schedules. Per case, per diem, DRG, % of charges, those terms. HIPAA.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses Related Grouping DRG codes, place of service codes (POS).
- Government Programs Specific Knowledge: o Medicare Medicaid programs, CHIP and LTC. o Eligible population, general covered services, regulatory body CMS and/or State Medicaid agency.

Gather and Document Requirements - Basic
- Ability to prepare a requirements document that is relatively simple. Knows how to construct one and what basic elements are contained in a requirements document. Attends meetings with the business.

Contracts - Intermediate
- Ability to read a contract and understand the operational requirements the contract creates. Read, review and understand a contract and tease out requirements from legal verbiage. Contracts are tedious and incumbent needs to be detail oriented and have ability to synthesize what they are reading into action, rules, requirements.

Business Analysis and Problem Solving-Analytics - Basic
- Critical thinking and problem solving methods.

Project Management
- Learning the basics of managing projects and becoming familiar with PM tools, techniques and methodology.

Testing - Basic
- Functions independently in the creation of simple test plans, including creation of test cases/scripts, setting up data for testing, validation, analyzing test results, integration, end-to-end testing, user acceptance testing (UAT), regression testing, documentation of results and presentation of results to user.

BEHAVIORAL COMPETENCIES

Strategic Leadership

Be Strategic
- Demonstrates understanding of the organization's mission and strategies.
- Works to clarify and understand the broader purpose and mission of own work.
- Integrates and balances big-picture concerns with day-to-day activities.
- Generates innovative ideas and solutions to problems.
- Identifies opportunities to increase efficiency, simplicity, and revenue.

Make Sound Decisions
- Approaches problems with curiosity and open-mindedness.
- Collects sufficient information to understand problems and issues.
- Analyzes problems and issues from different points of view.
- Applies accurate logic and common sense in making decisions.

People Leadership

Develop/Support Organizational Talent
- Relates to people in an open, friendly, and accepting manner.
- Treats others with respect.
- Listens carefully and attentively to others' opinions and ideas.
- Maintains positive relationships even under difficult or heated circumstances.
- Works cooperatively with people from different cultural backgrounds.

Ensure Collaboration
- Encourages people to draw on each other's strengths and experience to work together effectively, within and across teams.
- Appropriately involves others in decisions and plans that affect them.
- Provides honest, helpful feedback to others on their performance.
- Shares own experience and expertise with others.

Results Leadership

Show Drive and Initiative
- Demonstrates a "can-do" spirit, a sense of optimism, ownership, and commitment.
- Maintains a consistent, high level of productivity.
- Takes personal responsibility to make decisions and take action.
- Does not easily give up in the face of unexpected obstacles.
- Projects a positive image and serves as a role model for others.

Accountability/Optimize Execution
- Juggles many priorities and competing demands for one's time.
- Acts resourcefully to ensure that work is completed within specified time and quality parameters.
- Removes obstacles in order to move the work forward and/or get efforts back on track.
- Surfaces problems and issues before projects get derailed.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.

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