Business Systems Consultant

Sacramento, CA, United States

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

CANDIDATE MUST BE US Citizen (due to contractual/access requirements)

This position is responsible for system configuration implementation of the strategic business and functional infrastructure of the underlying systems that support the respective business platforms for the Medicaid Business Unit market served by Highmark. Performs configuration change management activities related to benefits, business rules, screen design and functionality, templates, workflows, provider contracts, user task analysis, personalization to different plans, and user interface design and design requirements for systems setup, configurations and onboarding of new plans/providers. Translates configuration rules, fee schedules, contract terms, provider data code sets, and benefits into systems parameters to ensure accurate managed care operations (i.e. enrollment & billing, claims processing, etc.). This job supports one or more analytical aspects of the application product life cycle, including capability enablement with cross-team dependencies within a product scope. Uses significant independent judgement and discretion to collaborate with customers on the most complex issues in order to understand capability needs, gather project specifications, create business cases and cost sheet analysis, translate high-level business needs into detailed requirements for new capabilities (and change request/enhancements on existing capabilities), analyze data to determine business problems, trends, or opportunities for process improvements, create/execute test plans, provide root cause analysis and corrective action plan, verify delivery of customer needs, and ensure quality delivery. Identifies, documents, and resolves risks, defects and issues. Analyzes market trends for competitive insight to correlate into business value statements. Uses functional and organizational knowledge to mentor Associate, Intermediate, and Senior Business Systems Analysts, as well as others outside of immediate team. Leads project teams or actively participates as a SME on the most complex projects (cross functional, with potential regulatory risk exposure, customer service & financial impacts). Acts as face to the customer; primary customer contact; may negotiate project requirements versus resources with customer. Resolves the most complex issues (may involve multiple systems) and/or develops alternative solutions with understanding of potential regulatory risk exposure and customer service & financial impacts, ensuring that resolution addresses all potential impacts. Includes hands-on configuration in production and test environments, incident tracking and resolution, release management and project management. Act as a SME on how the most complex new enhancement/applications are developed using an expert level of understanding of end-to-end processes and potential integration issues. Requires expert level of understanding the end systems impact of changes across enterprise-wide systems (including regulatory risk exposure, customer service & financial impacts). Develops policies & procedures in support of standardized and accurate configuration and maintenance. Remains informed of all health plan contracts and amendments as well as code sets, fee schedule and pricing changes made by health plans, CMS and/or the states’ Medicaid programs.

ESSENTIAL RESPONSIBILITIES

Lead in working with customers, Software Engineers, Architects, Capability Managers, and other team members to capture capability needs and drive quality business solutions. Create and maintain deliverables such as business vision, requirements, testing plan, testing schedule, testing scenarios, testing outcomes, user task analysis, wire framing, usability testing, personalization to different clients, and user interface design.

Participate in the full software development life cycle by actively leading or acting as lead in given area of expertise on agile scrum teams in various roles, including, but not limited to, Scrum Master, Business Technical Analyst, User Interface designer, Capability Manager, or Tester, based upon experience and need.

Provide required business and/or subject matter expertise on most complex issues for both project and production related activities, including new strategic programs or initiatives impacting current and existing systems.

Ensure compliance to required standards and all necessary approvals have been obtained throughout the project lifecycle.

Interface with the business areas, customers, partners, vendors, technical staff and project teams to drive value, return on investments and innovative solutions. This includes providing alternative solutions, including vendor solution acquisitions, with maximum benefits while reducing cost (e.g. cost benefit analysis, pros/cons of solutions).

Lead in supporting various aspects of requirements testing (e.g. testing plan, scenarios, documentation, defect management) to ensure minimal production defects are realized and completing analysis of the results tying back to customer impacts.

Communicate in an exemplary manner with team members, customers, partners and management, including assisting with or conducting requirement walkthroughs and sprint reviews, reporting project status, enabling vendor solutions and providing accurate and concise documentation.

Provide thought leadership and strategic direction in Product & Technology Solutions.

Other duties as assigned.

EDUCATION

Required

Bachelor's Degree in Business Management, Information Systems, or closely related discipline

Substitutions

None

Preferred

Master's Degree in Business Administration/Management or Information Systems

EXPERIENCE

Required

7 - 10 years in IS/IT

3 - 5 years in Project Management

3 - 5 years in the Health Insurance Industry

3 - 5 years in the Healthcare Industry

Preferred

5 - 7 years in Process Improvement

Experience with HealthEdge HRP

Hands on configuration experience

Experience working in a SaaS model

Knowledge of Medicare & Medicaid programs and their benefits

Health Source – previously known as Burgess

Agile

LICENSES AND CERTIFICATIONS

Required

None

SKILLS

Analytical Skills

Problem-Solving

Communication Skills

Report Writing

SQL

Project Management

Customer Service

Leadership

Agile Methodolgy

Agile Project Management

Language (Other than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Rarely

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

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Req ID: J246974