Business Analyst- Insurance Claims - Rapid Progression

Business Analyst- Insurance Claims

Health Edge/ Payer Solutions is a major plus

Lead Provider Business Analyst specifically focused on provider and network operations processes and contracts within government and commercial products (Medicaid, Medicare, CHP, QHP, etc.).

Job Description

• Serve as the main point of contact for the Provider workstream.
• In partnership with our Consultant, interview stakeholders, gather data, and define/document business requirements while ensuring a comprehensive understanding of needs and objectives. This includes, but is not limited to, system configuration, workflows, reporting, and capacity plans.
• Create an inventory of current state and future state workflows for all provider network operational processes including downstream processes (reporting, data feeds, and other applications).
• Identify any gaps in the current documentation of processes and partner with the Consultant on the creation of those.
• Understand existing gaps and/or pain points within the provider contract configurations, provider structure, payment models, etc., and collaborate with the Consultant to identify solutions for improvement.
• By working with the Consultant, identify industry best practices to enhance the provider network operations and drive system improvements.
• In partnership with the Consultant and various key Provider stakeholders, confirm that the product roadmap includes all requirements for the provider and network operational processes, the configuration/development work is prioritized appropriately, and all enhancements are identified based on business value.
• Review all provider and network specific business requirements, workflow documentation, policies, and procedures created by the Consultant and confirm accuracy prior to sign off.
• Collaborate with our QA teams and the Consultant to define all test cases, test scenarios, and acceptance criteria.
• Assist in the testing and validation of all applications used by the Provider workstream members against established requirements to ensure all test cases and scenarios pass.
• During testing, identify deviations from requirements and partner with the Consultant to remedy all issues.
• Contribute to the development of training materials that will be leveraged when conducting our formal training of team members.
• Review all training materials created by the Consultant to confirm accuracy and quality of materials.
• Monitor progress of the workstream and provide regular updates to stakeholders, addressing and escalating any changes in scope or roadblocks promptly.
• Ensure timeliness of all deliverables outlined in the project schedule.
• Act as a liaison between the Consultant, business stakeholders, development teams, and other critical resources, facilitating effective communication and alignment.
• Other duties as assigned