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Claims Business Analyst

 

We are looking for a Business Systems Analyst who will be accountable and responsible for all electronic data exchange processes. This includes coordination and set-up of new internal and external customers, data maps, and resolution of issues to support the EDI process.  Must be able to work on cross functional projects and complete setup and testing tasks related to client implementations and EDI maintenance work.

In addition to customer project responsibilities, the BSA will serve as a voice of the customer in providing internal consultation toward core product design, development and quality assurance operations.  The BSA will assist in process development and improvement initiatives in support of the growth of the Client Services organization.

Responsibilities:

  • Works with Customer personnel to identify and analyze business needs and requirements, utilizing a combination of industry-standard and InfoMC best practices and methodologies
  • Serving as a principal liaison between clients, vendors, and payers
  • Maintains all required system-level documentation, including but not limited to system configuration design documentation and function system design specifications for system enhancements/customizations
  • Promotes standard processes, policies and procedures within the InfoMC Client Services organization, working with the InfoMC leadership team to identify and implement operational/process improvement needs
  • Researching and troubleshooting X12 5010 transactions
  • Responsible for mapping and reviewing HIPAA EDI 5010 X12 formats (837, 835, 277, 834, 270/271 and 999) as well as industry standard and custom formats
  • Provide day-to-day production file monitoring and support
  • Other duties as assigned

Knowledge and Capabilities:

  • Comprehensive knowledge of HIPAA EDI 5010 X12 837, 835, 278, 276/277, 834, 270/271 and 999 files, including detailed understanding of all relevant loops and file structures is a must
  • Basic understanding of healthcare claims processing for professional and institutional claims
  • Knowledge of ICD-10 and Procedure codes for professional and institutional type billings
  • Knowledge of benefit enrollment and maintenance
  • Strong knowledge of PC-based office tools like Microsoft Word, Excel, Visio and PowerPoint
  • Ability to adjust to changing priorities and multiple concurrent projects
  • Self-directed, with strong multi-tasking, organizational and documentation skills
  • Good written and verbal communication skills
  • Being detail oriented, punctual, and disciplined is a must
  • Knowledge of SQL Server, SSIS and SSRS is a plus
  • Knowledge of Jira or similar agile tools
  • Must be a Team Player

The Role:

  • Provide regular status reports to both designated Project Managers and Functional/Departmental Leads/Managers
  • Work closely with Quality Assurance, Product Management and Development teams as the customer liaison (i.e. Voice of the Customer)
  • Work closely with other Client Services Team members and Project Team members in a matrixed project environment
  • Act as a primary Customer contact during key customer projects/implementations
  • Ability to look at customer needs and current market trends and make recommendations to the company in terms of services, processes and product optimization
  • Ability to manage schedule across multiple projects and execute within a fast-paced environment
  • Resourcefulness, with the ability to flourish under pressure and get the job done within deadlines and per expectations
  • High level of assertiveness, with the ability to communicate ideas and influence decisions cross-organizationally and within all levels of management
  • Provide leadership and establish and maintain effective working relationship with a service-oriented attitude in a team environment. Includes interaction with internal staff as well as customer staff members and the ability to effectively comprehend technical computing concepts

Qualifications:

  • Minimum of five (5) years of experience in a software product development/implementation environment
  • Minimum of five (5) years of the healthcare management (i.e. managed care) business domain knowledge
  • Minimum of five (5) years delivering software to the healthcare payer market
  • Bachelor’s Degree in Computer Science, Information Systems, Healthcare, Business, or equivalent work experience
  • Strong demonstrated knowledge of all Microsoft Office tools (Word, Excel, Access, Visio in particular)
  • Excellent problem solving, analysis, requirements management and decision-making skills
  • Demonstrated knowledge of general IT fundamentals including the following:
    • System analysis and design methodologies (e.g. Agile, RUP, Waterfall)
    • Object-oriented concepts, relational database management systems, XML
    • Relational database management systems and SQL knowledge a plus
  • Ability to travel to InfoMC’s client sites (up to 25% travel)

Highlighted benefits for being a Team member:

InfoMC is an equal opportunity employer with a generous compensation plan.

  • Excellent earning potential with qualifying annual bonuses
  • Health, Dental and Vision Plan
  • Weekly in-office yoga classes
  • Monthly lunch provided, fresh fruit, dry snacks available daily
  • Life insurance, short- and long-term disability
  • 401(k) retirement savings plan
  • Paid holidays and vacation
  • Gym on premises
  • Community volunteering opportunities
  • Conveniently located in the heart of Conshohocken, PA; adjacent to the Conshohocken train station for SEPTA Regional Rail Line
  • Conveniently located near the 130-mile Schuylkill River Trail

Please send resume to: resumes@infomc.com