Business Analyst II

Business Analyst II

Under minimal supervision, responsible, for maintaining Network Health's system configuration including benefits, accumulators, limits, fee schedules, contracts, and code sets. Apply specialized technical and analytic skills to produce analyses and applications to enhance the development of critical business functions. Translate health care business requirements and rules into system configuration by following departmental procedures, but with little direct supervision. Participate and represent the department on Network Health subcommittees to assess and communicate the impact of changes in business operations. Perform, with limited guidance, the analytical and technical tasks necessary to execute each phase of an analysis. Analytic tasks involve basic methodological design and data integration. Technical tasks require an understanding of relational databases and large data structures as well as knowledge of one or more of the following: SAS, SPSS, SQL, DBASE, MS Access, or Visual Basic. In addition, the Business Analyst II must have broad knowledge and experience in health care claims adjudication.


RequirementsMaintain claims adjudication system as it relates to the configuration of Network Health's lines of business. The business analyst II will maintain codes sets (HCPCS, ICD-9s, DRGs, CPT, Pend Approve Codes, Service Rules); identify how coding updates effect Network Health benefits and payment policies; analyze and implement annual updates to fee schedules and contracts as defined by Medicaid and Medicare; leverage analytical skill to support the contract and fee schedule creation and maintenance; and use technical skill to augment the maintenance and creation of the benefit, accumulator, and limits configuration. Act as internal technical resource. This includes training and mentoring the business analyst I and business associates; providing technical support and guidance to other staff in the areas of programming techniques, testing procedures, programming languages, and application uses; and working with major internal stake holders in the retrieval of mispayments due to configuration issues, this includes contracting, finance, provider relations, customer service, and claims departments. Create/maintain a testing process to ensure that configuration changes are implemented correctly and they do not adversely effect processing in other areas. Will create a general electronic bank of test claims to be used anytime the configuration of the system is altered, this will need to hit various sections of the system to ensure overall functionality is maintained. Check the results of this test batch against predetermined expected values. Generate specific test claims to target specific areas of the configuration. Develop methods for consistency and validity checking to assure that data is accurate and meaningful. Implement quality control processes for, benefit, code set, referral and auth rules, and contract set up processes. Provide key input into the development of analytic project plans to address varied business objectives related Business Configuration. This includes participation in establishing and maintaining timelines for individual tasks critical to overall project completion; tracking and reporting progress relative to these timelines and renegotiating timelines as appropriate; evaluating and selecting appropriate software tools and define the appropriate technical and analytic approach required to support project objectives; and developing methods for consistency and validity checking to assure that data is accurate and meaningful.


QualificationsB.S./B.A. degree required. Minimum three to five years work experience in a data management and analytic environment is required, two to three of which must be experience in a health care data management and analytic environment. Knowledge of industry-wide billing requirement and how to query for them in a database is essential. Deep understanding of payment methodologies and claims adjudication and healthcare claims testing experience a plus. Experience with HCFA and UB claims is required. Experience in a health care delivery setting is preferred. Must be able to work independently and with small work groups. Demonstrated technical and skills are essential. Demonstrated proficiency in the use of microcomputers, relational databases, spreadsheet applications, database and/or statistical software packages is required. Must have the ability to learn quickly, working with the manager on customized and complex projects requiring a high degree of analytical and technical skill. Must learn to recognize and take into account the broader business, operational, and financial impacts of configuration changes. Must understand and convey the nuances of Medicaid managed care business structure and apply this knowledge appropriately to analytic projects. Must understand the structure of system adjudication and its respective extracts in internal data warehouse, and construct conceptual and technical approaches to bridge gaps in data base differences. Must understand and be able to use the different software packages employed in Network Health for analytic purposes (e.g., SAS, Microsoft EXCEL, WORD, MS Access, Visual Basic). Must have good problem solving ability, initiative and judgment. Excellent oral and written communication skills required. SQL server or MS Access certification required