Operations Systems Analyst ll
The Operations Systems Analyst II role is responsible for the activities related to minor system updates, new health plan implementations and conversions within the Business Operations Teams.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Responsibility A: Performs daily review of business applications functions.
- Supports Claims staff with complex claim issues.
- Supports external users with application errors related to business applications.
- Identifies and develops process improvements outside of daily scope of work.
- Assists with the development of configuration standards and best practices.
- Maintains thorough and concise documentation for tracking of all provider, contract, benefit or Process Director changes related to Change Control request forms or issues for quality audit purposes.
- Makes recommendations and implement configuration changes to improve accuracy of processes and more efficiency for users.
- Handles fluctuating volumes of work and prioritizes work to meet deadlines and user needs of the Health Plan.
- Understands health plan’s environments and how application software can be used to increase efficiencies, cost effectiveness and quality of care.
- Researches and resolves claims/encounter issues, pended claims, processes director errors and updates system(s) as necessary.
Responsibility B: Supports the applications installation through the implementation cycle.
- Provides input to project implementation plan.
- Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans.
- Participates in defect resolution for assigned business applications.
- Develops training and materials/documentation for users relevant to the implementation of new Process Director workflows.
- Reviews and tests systems for conformance to functional and performance requirements.
- Prepares accurate and timely status reports for management.
- Identifies the impacts and dependencies of the new system.
- Demonstrates efficiencies of the new system and provide feedback to Management.
- Assists users to ensure smooth transition of system responsibilities to support.
- Researches and resolves issues and updates system(s) as necessary.
Responsibility C: Performs configuration analysis for system design associated with small and less complex projects.
- Suggests improvement processes to ensure system are working more efficiently and improve quality.
- Handles special projects and demonstrate ability to meet deadlines.
- Analyzes by applying knowledge and experience to ensure appropriate information has been provided.
- Assists with the design of user procedures.
- Assists users in determining specific requirements to increase system effectiveness.
- Analyzes and evaluates existing and /or proposed systems.
- Analyzes, interprets, and implements business requirements.
- Works in a consultative capacity.
- Conducts unit testing when appropriate.
Responsibility D: Analyzes system problems and modifications.
- Analyzes use of existing systems to identify and resolve problems.
- Evaluates business procedures and problems for process improvement.
- Recommends modifications to application design or current procedures to maximize advantages of existing resources.
- Assists users to resolve problems with application use.
- Documents issues, activities, and solutions employing standard methodology and utilities.
Responsibility E: Coordinates implementation and upgrades of systems.
- Coordinates departmental testing with Health Plan leaders and others, as needed.
- Assists with upgrade testing.
- Analyzes impact on users and determines if additional training is required.
- Communicates with Management to address problems and resolutions.
- Participates in training sessions with users to view new systems and upgrades.
- Works with internal and external stakeholders to understand business objectives and processes associated with the Health Plan business rules.
- Provides problem resolution to Health Plan Management and users to ensure all end to business requirements have been documented.
Knowledge and Skills:
- Knowledge of current business practices and business applications, including business applications used by the Health Plan and standard Health Plan software environments.
- A working knowledge of the healthcare industry.
- Process mapping, leadership, collaboration, written and verbal communication, detailed analytical skills, and organizational skills, ability to analyze the functionality of systems and their fit with specifications, ability to manage time with competing priorities, self-motivation, and the ability to work independently with minimum supervision.
- Additional preferred knowledge includes: Claims processing experience, provider contract set-up, Claim Edit system knowledge, ability to interpret business language into system coding edits, and testing of configuration builds.
The formal education and experience required for completely satisfactory performance in this job are as follows:
H.S. Diploma or GED or Bachelor’s Degree in computer science, business administration, healthcare administration or other related field
8 years health plan payor information systems
A Bachelor’s degree may substitute for the four (4) years of required work experience.