Blue Cross Nc
Health Care
SeniorBusinessSystemsAnalyst–ProviderNetworkPricing(MedicareAdvantage)
“Senior Business Systems Analyst – Provider Network Pricing (Medicare Advantage) at Blue Cross Nc. Skills: Provider Network Pricing, Facets, NetworX, Optum, Requirements Analysis, Systems Analysis, Medicare Advantage. Provide Network Pricing knowledge and support in system/application and procedural issues to the business and IT.. Use judgment and initiative to review, analyze and develop solutions and applicable business processes for business systems while identifying and quantifying the busine”
What You'll Achieve.
drive impactful solutions; optimizing processes and reducing operational and system impacts; making a direct contribution to organizational success; ensure quality, cost effectiveness, timeliness and customer service; improve system performance and user efficiency
Industry & Context.
resolve issues; resolution of large, complex production system problems; Analyze and verify results for accuracy, relevance and completeness. Provide impact assessments and make recommendations to the business owner regarding issues, risks, etc.
What They're Looking For.
Must Have
Bachelor's degree or advanced degree (where required), 5+ years of experience in related field, In lieu of degree, 7+ years of experience in related field
Nice to Have
Intermediate expertise with Facets, NetworX, and Optum, PC skills with intermediate expertise with Microsoft Excel, Intermediate CMS (Medicare) guidelines and rules knowledge, Understanding of provider contractual terms regarding pricing, Understanding of UB04 and HCFA1500 billing practices, interpersonal skills
What You'll Do.
Provide Network Pricing knowledge and support in system/application and procedural issues to the business and IT.
Use judgment and initiative to review
analyze and develop solutions and applicable business processes for business systems while identifying and quantifying the business impact of those solutions to ensure quality
timeliness and customer service
including the resolution of large
complex production system problems.
Provide systems (Facets
Optum) analysis expertise and regularly consider the business implications of the application of technology to the current business environment
Coordinate ongoing user support for ad hoc questions
and service requests.
Ensure efficiency of reporting and data tools for supported business area use and for trend analysis.
Coordinate the development of system support processes with coordinate daily to resolve production support issues
including application failures and user document
track and report all system support activities
Work collaboratively on projects and initiatives with the business and IT to test and implement long-term solutions by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used.
Act as Business Lead/Coordinator on large
complex departmental and/or some corporate projects/initiatives.
Facilitates project including intake
scheduling of projects
post-implementation support
and review and approve technical specifications
Serve as point of contact for business testing activities and influence testing strategy to ensure testing will appropriately meet business requirements
Analyze and verify results for accuracy
relevance and completeness. Provide impact assessments and make recommendations to the business owner regarding issues
Train/coach others on appropriate testing protocol
execution and test plan creation.
Assist IT and help identify business area impacts for hardware and software upgrades
and architectural enhancements as needed.
Configure and maintain critical system tables and data elements across multiple system environments
develop and implement configuration changes to improve system performance and user efficiency
How You'll Work.
Team & Collaboration
Acting as a vital liaison, you’ll represent your department, collaborating across teams to deliver innovative results while optimizing processes and reducing operational and system impacts.; In partnership with IT and business, you’ll lead efforts to resolve issues, test new solutions, and coordinate software upgrades and high-profile projects, making a direct contribution to organizational success.; Work collaboratively on projects and initiatives with the business and IT to test and implement long-term solutions by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used.; Assist IT and help identify business area impacts for hardware and software upgrades, security changes, and architectural enhancements as needed.
Communication Scope
Interpersonal skills
Process & Methodology
Act as Business Lead/Coordinator on large, complex departmental and/or some corporate projects/initiatives., Facilitates project including intake, scheduling of projects, implementation, post-implementation support, and review and approve technical specifications
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