Business Systems Analyst (Health Plan Claims, EDI, Benefits Solution, SDLC, agile, UML, MS Project) (closed)
Q Analysts is looking for a Business Systems Analyst for one of its clients located in Pasadena, CA
- Business Systems Analysts study the overall business and information needs of an organization, in order to develop solutions to business and related technology problems.
- A Business Systems Analyst role is usually undertaken prior to the system design, building and programming stages of the systems development process.
- Works closely with clients to identify business needs and the costs and benefits of implementing a computing solution.
- Construct IT definitions based on identified needs of the organization.
- Work with other IT experts to address networking and hardware needs.
- Devise and document a general system design based on the client's anticipated requirements. Negotiate options with the client.
- Ten+ years of experience in a senior solutions design role in Health Plan Managed Care environment
- Recent experience within past 2-3 years in Health Plan Claims, EDI and Benefits Solution Analysis and Design
- Prior consulting experience with an emphasis on delivery of complex enterprise solutions
- Experience using structured software life cycle & development methodologies; SDLC, Agile, etc.
- UML or comparable modeling knowledge and hands-on experience
- Experience in conducting vendor assessment and evaluating software packages and working with application vendors and system integrators on Request for Information/Request for Proposals
- Knowledge of using Microsoft Project and ability to work with Project Manager to create work plans
- Excellent problem-solving and decision-making skills, strong collaboration, documentation and presentation skills along with strong oral and written communication skills are a must.
- Analytical, troubleshooting, communication and presentation skills.
- Thinks and Acts creatively to come up with solutions that fulfills the project schedule and compliance requirements
- BS in CS or related field
- Knowledge of Comprehensive Delivery Process (CDP)
- Candidate should have experience working in a matrix team environment with strong customer relationship management and customer service skills.
- MBA or MS a plus
- Lead business and technical analysis efforts
- Independently Plan and Execute JAR/JAD sessions following a pre-defined structured and methodical approach
- Responsible for understanding current systems & their functional capabilities.
- Conduct business requirement and gap analysis sessions
- Develop use cases, and user requirement specification documents.
- Identify and evaluate solution alternatives
- Develop high level technical designs
- Liaise with developers, business analysts, and user representatives in application design reviews.
- Work closely with Project Manager to create and maintain the work plan
- Part C EOB: A CMS regulatory requirement with a 1/1/13 Go Live mandate for all Medicare Advantage Organization to produce monthly Explanation of Benefits (Ebbs) to the plan enrollees
- Administrative Simplification HCR: A regulatory project to implement CAQH Operating Rules 270/271 Phase I and II requirements.
- Overall Compliance date is 1/1/13