The Facets Benefits Configuration Systems Analyst II is responsible for leading and defining system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools.
location: DAYTON, Ohio
job type: Permanent
salary: $80,000 - 85,000 per year
work hours: 8am to 5pm
education: High School
- Lead and define system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools
- Identify, manage and document the status of open issues. Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments, utilizing TriZetto or Optum for research and correction.
- Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules.
- Plan/implement new software releases including testing and training
- Participate in meetings with business owners and users to achieve a Plan benefit design and Provider Reimbursement. Serve as liaison between IT and business areas to research requirements for IT projects, meet with decision makers to translate IT specifications and define business requirements and system goals
- Lead review of benefits or provider reimbursement as well as identify and design appropriate changes. Lead in the development and execution of test plans and scenarios for all benefit or reimbursement designs and for the core business system and related processes.
- Provides detail analysis of efficiencies related to system enhancement/automation. Review, analyze, and document the effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging these systems. Conduct preliminary studies to define needs and determine feasibility of system design
- Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues
- Ensure system processes and documents exist as basis for system logic
- Assists in resolution for potential business risk, including communication and escalation as necessary
- Applies use of tools to define requirements such as data modeling, use case analysis, workflow analysis and functional analysis
- Experience level: Experienced
- Minimum 5 years of experience
- Education: High School (required)
- Facets Benefits Configuration (4 years of experience is required)
- Medicare/Medicaid (3 years of experience is required)
- HIPAA Transaction Codes (3 years of experience is required)
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.