Glen Allen, Virginia
Business Analyst -- Claims Job Opening in Glen Allen, Virginia - Role Summary/Purpose
AllyAlign Health () is expanding our presence across multiple states. As a result we will be executing several implementation projects over the next 24 months in addition to operating current projects in 7 markets. We are seeking a person that can play the primary role of Business Analyst -- Claims with project responsibilities to facilitate these implementations and support system operations.
As a Business Analyst (BA) the person is the systems process expert on solutions and services offered by AllyAlign related to healthcare claims processing. The BA will be able to ensure that our plans and approaches to each market are thorough, appropriate, and compliant to standards and regulations that govern our business. The BA is expected to have project management and coordination responsibilities due to the highly collaborative nature of our work processes. This includes task management (self and team members) to ensure that plans are in place and executing to completion, record-keeping of action items and issues lists, facilitation of status meetings, etc.
Essential Responsibilities
Be the systems process expert on solutions and services offered by AllyAlign related to healthcare claims processing (e.g., benefit rules, provider fee schedules, claims adjudication), to include implementation, configuration, testing, rollout, and ongoing production support
Knowledgeable in the flow of data through the AAH solutions to be able to understand the inter-connectivity of the systems
Knowledgeable of the dependencies to/from claims for current markets and for new markets
Establish task list, action lists and issues/risks logs for assigned projects and track them on a timely basis
Adhere to standards to ensure discipline and controlled changes to systems
Facilitate periodic status meetings with the project team (including sub-contractors) to track progress of the projects, track action items to completion, and manage risks and issues
Participate in client status meetings, managing the agenda and notes from the meeting and tracking action items, issues and risks
Conduct end-user training as needed
Help ensure AAH has a consistent track record of timely and quality market launches
Bachelor?s Degree
Require knowledge of Healthcare Claims Processing Systems for Payor, preferably EZ-CAP
Require strong of Medical Billing/Coding
Require strong knowledge of benefit rules and experience in creating and maintaining system configuration to implement the benefit rules
Proficiency in computer skills in Microsoft Office Suite products, especially Microsoft Excel, preferably including Microsoft Project
5+ years of demonstrated successful experience in the healthcare industry
Personally driven and able to work in a fluid environment with general direction
Strong interpersonal skills, with demonstrated ability to work independently as well as with a team
Ability to energize, develop, and build rapport at all levels within an organization
Demonstrated ability to analyze complex customer situations and present solutions that are viable, executable and meet the requirements of the customer (internal and external)
Basic SQL knowledge, in order to review data for trends, metrics, results, and incorporate review results in analysis
Proven customer (internal and external) acumen and relationship building skills in a healthcare environment
Willingness to travel with occasional overnight stays depending on business needs
Strong written and verbal communication and clear thinking skills with the ability to synthesize complex issues into simple messages
Knowledge of Healthcare industry and market place trends, specifically related to managed Medicare, managed Medicaid, dual eligible members and insurance products
Demonstrated successful experience tracking projects implementing both systems and processes
Job Type: Full-time
Salary: $70,000.00 to $80,000.00 /year
Required education:
Bachelor's
Required experience:
healthcare claims information systems for Payors: 5 years
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