Projé has an exciting opportunity for a full-time Senior Business Analyst. The Senior Business Analyst will assist in the assessment, analysis, testing, requirements gathering, and documentation processes for the Health Plan operations. The ideal candidate will possess detailed knowledge of claims, clinical editing, utilization management, and enrollment.

Responsibilities

• Conducts the analysis and documentation of current state and future state, documenting gaps and user requirements in the design of the future state workflows, to optimize system functionality. Along with the client, modifies or creates new workflows and testing to improve processes

• Facilitates and elicits requirements for projects, while effectively managing changes and conflicts during specifications gathering process

• Develops use cases, test scenarios, test cases, clearly communicate testing methodologies and apply testing methodologies to ensure application quality

• Manages Clinical Business Process Modeling/Workflows utilizing Microsoft Visio

• Develops and documents Desk Level Procedures and Standard Operational Procedures

• Participates in meetings and presentations effectively and professionally. Provide documentation for meetings to report progress, issues and possible resolution

• Establishes and maintains collaborative relationships with all associated departments, workgroups, and vendors as required. Communicates effectively and concisely to promote positive relationships

• Supports clinicians, managers, project managers and end-user timelines for assigned tasks

Key Qualifications

• Solid understanding of health plan (payer) clinical operations in the health insurance space

• In-depth understanding of Health Plan processes, including but not limited to, claims processing, clinical editing, utilization management, and enrollment

• Knowledgeable in Healthcare Effectiveness Data and Information Set, Utilization Review Accreditation Commission, and National Committee for Quality Assurance

• Strong analytical, problem solving, negotiation, and collaboration skills

• Proven ability to participate in several projects at the same time

• Expert skills with MS Office Suite, Visio, MS Project, and SharePoint required

• Experienced in Medicare, Medicare Advantage, and Medicaid

• Knowledge of Health plan software systems including Facets, QNXT, and/or Care Management systems

Perks

• Competitive pay and bonuses

• Excellent benefits (medical, dental, vision)

• 401K with percentage company match

• Paid holidays and vacation days

• Flexible schedule

Education and Experience

• A minimum of 5 years of Health Plan experience is preferred.

• A Bachelor's degree in Healthcare Administration or a related field is required. Equivalent experience may be considered in lieu of a Bachelor's degree.