Job Specifications:

1.     Education: Bachelor’s degree in Information Technology or similar degree

2.     Experience: 3-4 years in a business analyst, or project management role

3.     Knowledge and Skills:

3.1.  Demonstrate competence in the areas of critical thinking, project management, interpersonal relationships, and technical skills.

3.2.  Demonstrate knowledge of U.S. healthcare terminology and code sets, including ICD-10, HCPCS, and CPT-4 coding systems.

3.3.  1-2 years experience with EDI processing and terminology, specifically HIPAA 5010 EDI transactions.

3.4.  1-2 years experience of Microsoft SQL Server or other SQL database platform to perform basic queries and analysis.

4.     Behavioral Competencies:

4.1.  Effect team player with interpersonal skills and relate well with co-employers, patients and customers.

4.2.  Behavioral sensitivity, maturity and diplomacy in addressing complex situations and handling irate customers.

4.3.  Strong ethics and a high level or personal and professional integrity.

4.4.  Strong oral and written skills.

 Duties and Responsibilities:

1. Gathers and prepares preliminary analysis of system set up based on information from internal and external sources.
2. Prepares recommendations for systems’ set – up and design.
3. Performs business analysis and collaborates with business users to establish and document system requirements.

4. Develops, maintains, audits and reviews the configuration functions of ClaimScape and HIPAA Suite systems. Identifies and corrects inconsistencies in system configuration to ensure set up is consistent with contracts and benefits.
5. Conducts testing, designing, coordinating, execution and review of test systems result.
6. Administers new and revised policies/procedures and assigned programs/projects.
7. Develops, implements and tracks processes and systems to improve, analyze & measure internal department performance to ensure continuous improvement of all company operations and internal and external customer satisfaction.
8. Ensures interface design and development between various distributed systems. Understands interface protocols and specifications and how information can flow between systems. Can be called upon to mediate interface issues between systems and between vendors.
9. Develops new training programs for end users. Develops and maintains supporting documentation for project design, development, coordination and implementation including minutes, diagrams, and specifications. Ensures that proper education and documentation is completed for assigned projects
10. Attends user/vendor and departmental meetings established to monitor end user issues. Coordinates with vendor representatives concerning all issues with sytems.

Job Summary:

Responsible for gathering and preparing preliminary analysis of system set up based on information from internal and external sources. Develops, maintains, audits and reviews the configuration functions of ClaimScape, and HIPAA Suite. Plans and implements EDI workflows into said systems. Identifies and corrects inconsistencies in system configuration to ensure set up is consistent with contracts and benefits.

Also responsible for leading the installation of system upgrades and new system implementations, of minimal complexity and those involving such activities as planning and evaluation of upgrade impact, scheduling downtime, developing, monitoring and providing status, testing, system QA and roll-out as well as upgrades of system releases and system modifications which includes defining and delegating assignment of tasks, monitoring deadlines and ownership of responsibilities.