Senior Business Systems Analyst - Provider Network Pricing (Medicare Advantage)

Job Description

As a Senior Business Systems Analyst - Provider Network Pricing (Medicare Advantage), you will leverage your advanced expertise in both functional and technical areas for claims and provider pricing to drive impactful solutions across sophisticated systems and applications (i.e., Facets, NetworX, Optum). You'll play a key role in shaping business strategies by defining, assessing, and validating requirements, and designing effective business and technical solutions for complex challenges within Provider Network Pricing. Acting as a vital liaison, you'll represent your department, collaborating across teams to deliver innovative results while optimizing processes and reducing operational and system impacts. In partnership with IT and business, you'll lead efforts to resolve issues, test new solutions, and coordinate software upgrades and high-profile projects, making a direct contribution to organizational success.

What You'll Do

• Provide Network Pricing knowledge and support in system/application and procedural issues to the business and IT.
• Use judgment and initiative to review, analyze and develop solutions and applicable business processes for business systems while identifying and quantifying the business impact of those solutions to ensure quality, cost effectiveness, timeliness and customer service, including the resolution of large, complex production system problems.
• Provide systems (Facets, NetworX, Optum) analysis expertise and regularly consider the business implications of the application of technology to the current business environment
• Coordinate ongoing user support for ad hoc questions, inquiries, and service requests.
• Ensure efficiency of reporting and data tools for supported business area use and for trend analysis.
• Coordinate the development of system support processes with IT; coordinate daily to resolve production support issues, including application failures and user errors; document, track and report all system support activities
• Work collaboratively on projects and initiatives with the business and IT to test and implement long-term solutions by eliciting and documenting business requirements and preparing appropriate functional specifications while considering technical capabilities of the system/application and ensuring an integrated approach is used.
• Act as Business Lead/Coordinator on large, complex departmental and/or some corporate projects/initiatives.
• Facilitates project including intake, scheduling of projects, implementation, post-implementation support, and review and approve technical specifications
• Serve as point of contact for business testing activities and influence testing strategy to ensure testing will appropriately meet business requirements
• Analyze and verify results for accuracy, relevance and completeness. Provide impact assessments and make recommendations to the business owner regarding issues, risks, etc.
• Train/coach others on appropriate testing protocol, execution and test plan creation.
• Assist IT and help identify business area impacts for hardware and software upgrades, security changes, and architectural enhancements as needed.
• Configure and maintain critical system tables and data elements across multiple system environments
• Analyze, develop and implement configuration changes to improve system performance and user efficiency

What You Bring

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field
• In lieu of degree, 7+ years of experience in related field

Bonus Points

• Intermediate expertise with Facets, NetworX, and Optum
• Strong PC skills with intermediate expertise with Microsoft Excel
• Intermediate CMS (Medicare) guidelines and rules knowledge
• Understanding of provider contractual terms regarding pricing
• Understanding of UB04 and HCFA1500 billing practices
• Strong interpersonal skills

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.
• Work-life balance, flexibility, and the autonomy to do great work.
• Medical, dental, and vision coverage along with numerous health and wellness programs.
• Parental leave and support plus adoption and surrogacy assistance.
• Career development programs and tuition reimbursement for continued education.
• 401k match including an annual company contribution
• Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.


*Based on annual corporate goal achievement and individual performance.


$89,174.00 - $142,679.00

Skills
Business Processes, Business Process Improvements, IT Service Management (ITSM), Problem Management, Process Improvements, Requirements Analysis, Requirements Gathering, Solutions Development, Systems Analysis, Technical Development

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: View email address on click.appcast.io.