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