ba iii - enrollment
Post on 07-Aug-2015
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Job Summary
The Business Analyst III acts as the primary liaison between IT and the operational departments within the
organization. This position functions in a trusted advisor role. It provides subject matter expertise to the clients
in which it serves through analysis and the development of business and functional requirements for initiatives
of all sizes. The Business Analyst III serves in a relationship management role to increase customer service,
and participates on project teams to assist in timely delivery of IT project initiatives. This role also serves as a
mentor to team members.
This position will primarily support the Enrollment Dept functional area of the organization.
Responsibilities
Serves as technical and subject matter expert for initiatives involving member enrollment application
processing. Responsibilities include but are not limited to the rules and processes involved in inbound and
outbound 834 file processing, maintenance of the enrollment data in the core application (Facets), and
creation of outputs related to changes made in the enrollment records
Understands the needs and prioritization of work within the Enrollment department
Leads and guides workgroups through the evaluation of current state processes. Performs analysis to
define opportunities to create improved future state workflows/solutions (end-to-end process flow
development)
Attends state and CMS regulatory meetings on enrollment topics
Assists management and end users in evaluating vendor software applications.
Leads and facilitates requirements and design sessions. Documents business and functional specifications
used for software design and development including software traceability matrices and use case diagrams.
Conducts requirements reviews to obtain sign-off from project/operational stakeholders.
Sets projects timelines with identified deliverables. Creates task lists/project plans for smaller initiatives.
On larger project initiatives completes assignments as defined by the Project Team.
Reports project status updates to stakeholders
Identifies issues and facilitates problem resolution for manual, batch and online environments. Ability to
interrogate error codes
Uses metrics and data to lead process improvement initiatives
Analyzes and queries data; has knowledge of the Facets data models
Data mapping, including the creation of file specifications; source to target mapping
Testing, including the creation of test plans, test scenarios, test data and understanding of outcomes
Mentors customers and peers
Communicates internally and externally with all levels of employees including senior management
Interacts with all areas of Information Technology as well as software vendors
End-to-end ownership of assigned initiatives – requirements through implementation
Keeps current with industry trends and state/federal compliance initiatives
Participates in vendor and industry user groups
Qualifications
BA/BS - Bachelors Degree or equivalent required. Degree in Computer Science or Computer
Programming a plus
Minimum 5-8 years previous experience as a Business/Systems Analyst
Health Care Industry experience
Previous experience with customer enrollment data and workflows including the acceptance and processing
of enrollment files from the NY State of Health, Maximus and Dept of Social Services (Roster processing)
Experience with group, subscriber, and product concepts; enrollment rule requirements by product line
Ability to work with inbound and outbound files as well as query and map data
Experience with the TriZetto MMS process and of Facets Group, Subgroup, Class/Plan, Product and
Subscriber/Family applications
Strong knowledge of EDI 834 preferred; NYS Roster and KIDS system formats a plus
Knowledge of departmental outputs of the enrollment process such as contracts and ID Cards.
Knowledge of health care benefits and product offerings including NY State of Health exchange plans,
Medicaid, Medicare, Dual, Child Health Plus, Managed Long Term Care and FIDA programs
Proficiency with SQL (querying, analyzing and mapping data)
Demonstrated ability to ..
o Lead and elicit business needs and requirements from a diverse set of stakeholders
o Document and communicate requirements to the stakeholders, developers and testers.
o Construct or modify use case diagrams and process models.
o Create and execute test scenarios
Experienced in full software development life cycle
Understanding of the concept of online and batch environments
Excellent PC skills utilizing Microsoft Office software (Excel, Word, Visio, PowerPoint, and Access)
Proven problem solving and analytical skills
Detail oriented with the ability to manage multiple tasks simultaneously
Excellent organization and follow through skills
Excellent interpersonal, written and verbal communication skills
Ability to build and maintain good rapport with internal and external customers and handle situations with
confidence, tact and resourcefulness
Flexible, adaptable with the ability to work under pressure to meet deadlines in a fast paced environment
Strong team player
Able to research and work independently as well as in a team
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