Lead Healthcare Business Analyst

The Business Analyst provides expertise in the process of screening, framing and modeling business requirements for process enhancements, process improvements, and/or cost savings. Reviews best practices and makes recommendations on improving current practices and processes. Responsible for organizing and documenting requirements into Business Requirements Documents (BRDs) and Report Requirements Designs (RRDs). Develops recommendations to solve problems and issues related to business operations. Generally works on large scale projects of significant complexity. Accountable for delivering work products that meet business needs.

Qualifications

Essential Functions/Job Qualifications

1. Conducts and facilitates sessions to develop and coordinate the requirements, specifications, design, and testing efforts for medium to large projects.
2. Analyzes business workflow and system needs for new features and enhancements; assists in data mapping.
3. Updates existing BRDs and RRDs or creates new BRDs and RRDs as required.
4. Reviews, analyzes, and evaluates business processes for improvement or enhancement as needed.
5. Supports or leads the process of screening, framing and modeling ideas that capture business requirements.
6. Develops and executes test strategies, plans, scenarios, and tracks resolution to identified defects.
7. Recommends promotion of software to production based on satisfactory test results.
8. Defines and documents business and IT system processes and workflows. Models AS-IS and TO-BE processes.
9. Defines and develops test plan documentation to support system validation and/or User Acceptance Testing.
10. Conducts gap analysis and uses analytical skills to identify root cause and assist with problem management.
11. Creates analytical tools necessary to support Operational analysis.
12. Creates, runs and analyzes standing and adhoc reports as required.

Knowledge/Skills/Abilities

1. Understands the basic concepts of project management according to PMBOK and Project Management Lifecycle.
2. Demonstrated understanding of Software Development Life Cycles (SDLC).
3. Intermediate level of knowledge in Microsoft applications (Word, Excel, MS Project, PowerPoint, Visio) and SharePoint.
4. Intermediate level knowledge: SQL/VB, Crystal Reports, Access, and Relational Database tables and tools.
5. Ability to articulate an appropriate course of action based on reading standard project documentation (charter, work plan).
6. Understanding of Medicare and Medicaid lines of business.
7. Ability to document business analysis deliverables such as requirements, workflow diagrams, and testing documentation.
8. Ability to work independently as well as within a team.
9. Attention to detail and accuracy.
10. Ability to multi-task skills and prioritize workload.
11. Excellent verbal and written communication skills.
12. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
13. Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.

Required Education: Associate’s Degree or equivalent experience.

Required Experience:

1. 6+ years experience with increasing responsibilities as a business analyst.
2. 4+ years experience with health care payer organizations.

Preferred Licensure/Certification:

CBAP/CCBA or PMI-PBA certification.

Preferred Experience:

1. 4+ years of managed care experience.
2. 2+ years Medicaid/Medicare experience.
3. 2+ years exposure to utilization management, care management and/or disease management.
4. Demonstrated expertise in a variety of concepts, practices, and procedures applicable to utilization management, care management and/or disease management functional areas.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Candidate must be GC EAD, Green Card or US Citizen; candidate needs to be located in Western States.