Business Operations Technical Analyst

About the role

MedImpact Healthcare Systems, Inc. is looking for an experienced system technical analyst to support claims testing processes for new plan and product implementations.

Responsibilities

• Recommends and/or makes decisions regarding the development and execution of testing strategies for individual clients and general test scenarios used across broader market segments.
• Develops quality assurance testing strategies and quality testing specifications to validate business requirements.
• Reviews, analyzes, and evaluates business test systems and end-user needs.
• Performs process assurance functions to ensure testing requests and associated activities adhere to defined policies and procedures.
• Defines and documents use requirements to assist in the development of custom test cases and develops test plans to support the requirement testing and validation phase.
• Acts as the liaison between the testing and validation end-users, Implementations and IT department.
• Partner with Implementation and Client Team Members to support the testing and validation requests for new product and plan implementations.
• Safeguards client configuration programming to ensure completeness and accuracy to defined specifications.
• Supports software changes and ensures quality on-time deliverables.
• Assists internal department with technical claims testing setup.
• Supports the development of innovative tools and strategies for testing the coding and supporting structure of the pharmacy benefit plans to ensure accurate claims processing.
• Ensures the integrity of the benefit, pharmacy network, formulary and other edits applied to a client's configuration for claims processing.
• Develops project plans, prioritizes project tasks, and provides status updates on project progress.
• Works with business partners to develop and execute test plans for new client implementations, eligibility records, and benefit, group, & carrier linking.
• Analyzes claims adjudication results against requirements and identifies and reports discrepancies and inaccuracies.
• Makes recommendations and develops solutions to enhance the accuracy of POS system changes and configuration setups.
• Determines accuracy of adjudication configurations and approves data changes from the test environment to production.
• Mentors and trains team members and peers.
• Leads the Testing and Validation team in solving new and unexpected problems that arise during the implementation phase of the project.
• Improves processes, open to suggestions and experimentation, interested in re-engineering only when measurable benefits can be gained.
• Determines length and difficulty of tasks and projects, assigns task/people and anticipates problems or roadblocks.
• Serves as a subject matter expert for claims adjudication configurations and expected outcomes.
• Partners closely with Information Technology Data Programmers/Analysts in development of advanced/complex programming of modifications that impact the testing environment.
• Provides recommendations for the maintenance of the claims testing environment.
• Proactively seeks out opportunities to improve claims testing processes through technology and process improvement solutions.
• Develops efficient SQL queries to research, gather data and identify solutions.
• Serves as a subject matter expert for claims adjudication configurations and expected outcomes.
• Partners closely with Information Technology Data Programmers/Analysts in development of advanced/complex programming of modifications that impact the testing environment.
• Provides recommendations for the maintenance of the claims testing environment.
• Proactively seeks out opportunities to improve claims testing processes through technology and process improvement solutions.
• Develops efficient SQL queries to research, gather data and identify solutions.

Qualifications

• BS/BA and 3+ years’ experience or equivalent combination of education and experience.
• Advanced expertise in MS Office; Word, Excel, PowerPoint, Access and Outlook.
• Working knowledge of Oracle, SQL, Visio, along with working knowledge of healthcare operating systems and MedImpact file layout specifications.
• None required.

Skills and Abilities

• Advanced expertise is MS Office; Word, Excel, PowerPoint, Access and Outlook.
• Working knowledge of Oracle, SQL, Visio, along with working knowledge of healthcare operating systems and MedImpact file layout specifications.
• Strong analytic, verbal and written communication skills.
• Detail-oriented with high degree of accuracy and organizational skills.
• Able to effectively work as a team player as well as independently.
• Excellent investigative, problem resolution, judgment and decision-making skills required.
• Excellent presentation and consultative skills, working with internal and external clients at various levels in the organization.

Physical Demands

• Sit and talk or hear.
• Stand; walk; use hands to finger, handle, or feel and reach with hands and arms.
• Lift and/or move up to 25 pounds.

Work Environment

• May regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration.
• The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

• This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements).
• Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Travel

• This position may require domestic travel.

Company Perks

• Medical / Dental / Vision / Wellness Programs.
• Paid Time Off / Company Paid Holidays.
• Incentive Compensation.
• 401K with Company match.
• Life and Disability Insurance.
• Tuition Reimbursement.
• Employee Referral Bonus.

Equal Opportunity Employer

• Male/Female/Disabilities/Veterans.