Job Information
WellSense Business Analyst, Payment Strategy in United States
Business Analyst, Payment Strategy
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294330)
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
The Business Analyst, Payment Strategy is responsible for a variety of specialized data analysis/management, reporting functions, documenting processes, and performing user acceptance testing in support of the Plan’s provider payment strategy. The individual will need to be able to translate operational and business gaps, needs, and opportunities into requirements for both business processes and work with IT counterparts to build sound business cases and requirements.
Our Investment in You:
· Full-time remote work
· Competitive salaries
· Excellent benefits
Key Functions/Responsibilities:
Performs and guides others through the business requirements gathering process.
Analyzes benchmarking data, reports, processes, and measurements.
Develops and documents business, analysis and reporting requirements.
Translate business requirements into product-specific designs and configuration, detailed requirement specifications and use cases.
Coordinates a variety of projects/requests simultaneously and ensures timely completion in accordance with business initiatives.
Transforms data into meaningful, professional, and easy to understand formats for leadership review and develops recommendations and reviews findings with peers and leaders.
Collaborates with relevant stakeholders to develop, execute and monitor project plans, and performance improvement plans.
Works closely with Sr. Business Analysts, Project Managers, and SME teams to ensure requirements are captured and documented correctly.
Utilize stakeholder feedback and/or process performance information to identify potential continuous improvement opportunities.
Provides information and participates in meetings as requested.
Develop business context diagrams (e.g., business data flows, process flows) to analyze/confirm the definition of project requirements.
Ensure adherence to enterprise standards for gathering and documenting project requirements.
Updating, implementing, and maintaining process and procedure documents.
Deliver functional specifications, design documents, business process workflow and related documentation for new development projects and or enhancement and modification request.
Other duties as assigned.
Supervision Exercised:
· None
Supervision Received:
· General supervision is received weekly.
Qualifications:
Education Required:
- Bachelor's Degree in a related field or the equivalent combination of training and experience.
Education Preferred:
· AHIMA or other nationally recognized coding certification.
Experience Required:
Minimum 3 years experience Business Analysis experience in provider billing/payment or claim processing environment.
Minimum 3 years experience managing complex operational processes and data sets.
Experience Preferred/Desirable:
Experience with Medicaid and Medicare managed care health care or health plan experience
Knowledge of operational/technical aspects and impacts of health care contracts.
Cognizant Facets claim adjudication system.
Optum claim adjudication software.
Experience working with spreadsheet and database applications as well as SQL and/or relational data structures.
Required Licensure, Certification or Conditions of Employment:
· Successful completion of pre-employment background check
Competencies, Skills, and Attributes:
Highly developed organizational skills.
Effective collaborative skills throughout all levels of an organization.
Ability to execute initiatives and programs effectively through change management, engagement of staff, and training.
Ability to respond to constantly changing circumstances, work under short deadlines, and handle a necessarily ambiguous role required.
Comprehension and appreciation of the complexities inherent in an organization and of its corresponding corporate culture.
Strong oral and written communication skills; ability to interact within all levels of the organization.
A strong working knowledge of Microsoft Office products.
Demonstrated ability to successfully plan, organize and manage projects.
Detail oriented, excellent proof reading and editing skills.
Working Conditions and Physical Effort:
Regular and reliable attendance is an essential function of the position.
Work is normally performed in a typical interior/office work environment.
No or very limited physical effort required. No or very limited exposure to physical risk.
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294330)
Important info on employment offer scams:
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not reach out to individuals via text, we do not ask or require downloads of any applications, or “apps”, and applicant screenings, interviews and job offers are not conducted over text messages or social media platforms. We do not ask individuals to purchase equipment for, or prior to employment. To avoid becoming a victim of an employment offer scam, please followthese tips from the FTC (https://consumer.ftc.gov/consumer-alerts/2023/01/looking-job-scammers-might-be-looking-you?utm_source=govdelivery) .