Business Systems Analyst (Health Plan Claims, EDI, Benefits Solution, SDLC, agile, UML, MS Project) (closed)

Pasadena, CA
DOE compensation
Recruiter Comment: Seeking BSA with Medical Claims, Medical Billing and HIPAA exp for several contracts in Pasadena and Pleasanton, CA.
Job Description

Q Analysts is looking for a Business Systems Analyst for one of its clients located in Pasadena, CA

Requisition Description:

 

  • 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.  

BASIC QUALIFICATIONS

 

  • 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  

PREFERRED QUALIFICATIONS:

 

  • 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 

JOB RESPONSIBILITIES:

 

  • 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  

PROJECT INFORMATION:

 

  • 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