OverviewAs a Business Analyst – Utilization Management, this position will be responsible for utilizing instructions, commonly used concepts, practices and procedures and appropriate system tools and resources to perform their job. This position will also develop various test plans that ensure that business requirements have been met while understanding business unit activities, goals and critical success factors that influence systems applications.
Benefits:
- Fun, friendly, & experience team environment
- Ability to participate in projects that have real impacts on corporate goals
- In person, hybrid, or telecommute work options available
- Starting salary based upon skills and experience: $78,000 - $98,500 annually plus robust total rewards package
Responsibilities
- Analyze, design, configure, test, implement, and support Utilization Management (UM) and referral-related system solutions.
- Partner with business stakeholders, IT teams, and vendors to define requirements, resolve issues, and implement system enhancements.
- Serve as a subject matter expert for UM configuration, workflows, business processes, and related system functionality.
- Maintain ownership of Prior Authorization, Referral, Criteria Review Software, referral correspondence, work queue configuration, reporting, and production support.
- Develop and maintain business requirements, process documentation, policies, procedures, and test artifacts.
- Perform validation and quality assurance testing of system configurations and changes to ensure accuracy and compliance with business requirements.
- Analyze data discrepancies, identify root causes, and recommend process or system improvements.
- Provide guidance, training, and mentorship to team members and support cross-functional project initiatives.
- Participate in change management, implementation, and continuous improvement efforts to enhance operational efficiency and member/provider experience.
Qualifications
- Knowledge of health insurance plans and application / utilization management
- Experience working in an Epic – Tapestry strongly preferred
- 2+ years of experience in Business Analyst role or equivalent experience
- 2+ years of experience in prior support of systems including health insurance claims adjudication, eligibility, provider contracts, provider enrollment, EDI, or benefit plans.
- Bachelor’s or Associate’s degree or related experience.
- Advanced MS Office skills
- Developing fluency with tools such as BusinessObjects, Chronicles, Visio
- Strong verbal and written communication skills – able to effectively description ideas or difficult/ sensitive situations
- Ability to interact across team/departments to achieve project and department goals
- Ability to understand and discuss technical software issues with others
- Ability to adapt to changing circumstances, accepting uncertainty and/or unpredictability
We offer an excellent benefit and compensation package, opportunity for career advancement and a professional culture built on the foundations of Respect, Responsibility, Resourcefulness and Relationships. To support a safe work environment, all employment offers are contingent upon successful completion of a pre-employment criminal background check.
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