AmeriHealth Caritas Responsibilities: in Philadelphia, Pennsylvania

Responsibilities:

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Work directly with business clients, PMO, all levels of management, technical staff, architects, and vendors to analyze Business Requirements and create clear & concise Functional Specifications according to standards for technical staff to use in Detailed Design and software development. Actively participate in requirements elicitation and apply a combination of business and technical knowledge to solve business problems with cost-effective technical solutions. Manage relationships with all stakeholders to control the flow of work. Use creative problem solving skills to remove barriers and effective communication skills to keep all parties informed regarding status. Become SME (over time) in Medicaid and Medicare software applications and interactions. Mentor junior team members.

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  • Analysis and documentation of current and future processes/systems and delivery of documentation for the effective implementation of stated processes.

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  • Hands-on interaction with stakeholders to create clear & concise Business Requirements, Functional Specifications, Data Flows, and/or other SDLC deliverables according to ACFC standards.

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  • Manage work assigned to ACFC vendors as it relates to Medicaid and Medicare deliverables.

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  • Prepare feasibility and cost analysis determinations for projects.

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  • Interface with business clients, PMO, all levels of management, technical staff, architects, vendors, and others with minimal supervision to achieve project goals and initiatives.

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  • Effectively communicate with all stakeholders, regardless of technical understanding, and ability to convey technical concepts to non-technical stakeholders in a manner that enables good business decision making.

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  • Demonstrate superior customer focus always. Build consensus among stakeholders as it relates to large-scale business problems and issues.

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  • Assist in managing large scale projects, lead appropriate resources, and determine project requirements and deliverables to ensure successful implementations to meet user needs.

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  • Critically assess impacts to the business processes as well as technical process flows and lead the introduction of new concepts and business processes.

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  • Develop and/or enhance a working knowledge of Medicaid and Medicare Healthcare Managed Care Activities: Marketing, Member Services, Health Services, Claims, Enrollment, Provider Relations, Finance, Vendor relationships and any other functional area in order to effectively communicate with all stakeholders.

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  • Demonstrate strong problem solving capabilities and approach each problem in a logical and analytical manner with high degree of perseverance; produce definitive statement of the issues, and identification of alternative solutions, the recommended course of action, and the consequence of the decision.

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  • Anticipate and keep manager and project staff informed of future or planned events that could impact implementations.

\r\n\t

  • Use sound judgment in matters where there is established or little precedent and in keeping management informed of specific problems or events that impact the departmental or overall corporate objectives.

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  • Work effectively both as a member of a team and independently; establish good judgment regarding routine, significant, and sensitive matters or those issues for which direct response is inappropriate and promptly apprise Manager.

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  • Professionally lead productive meetings, deliver professional oral or written presentations.

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Education/Experience:

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  • Four-year degree in Management Information Systems or related field, or four years of related work experience.

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  • At least eight years of experience in business and functional requirements gathering.

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  • Experience in managed care required. Possess solid understanding of the industry; high level understanding business applications; sound understanding of organizational and process development.

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  • Technical experience strongly preferred (solid working knowledge of programming and constructs).

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  • Experience with MS Office products, including Visio and MS Project.

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  • Prior experience with user stories and agile scrum development preferred.

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  • Experience in Medicaid and/or Medicare strongly preferred.

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  • Claims experience preferred; TriZetto Facets experience a plus.

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  • Medical Management experience preferred; ZeOmega experience a plus.

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  • Project management experience a plus.

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  • Experience working directly with or for a software vendor a plus.

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  • Working knowledge of complete SDLC required.

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  • Demonstrated effective written and verbal communication skills required.

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  • Proven track record of creating professional, concise, complete functional specifications.

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  • Ability to manage multiple concurrent tasks and projects required.

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  • Superior troubleshooting & creative problem solving skills required.

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  • Ability to manage multiple tasks with changing priorities required.

\r\n\t

  • Accommodate work schedule and works extra hours to meet crucial project deadlines as required.

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  • Ability to work effectively with end-users, project teams, management, and vendors with minimal supervision required.

\r\n\t

  • Ability to work as a member of a team, as well as individual contributor, required.

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  • Working knowledge of HIPAA and X12 EDI formats a plus.

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  • Working knowledge of Oracle database and tools e.g. TOAD, SQL Developer a plus.

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  • MS SQL working knowledge for data research/analysis a plus.

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  • Keeps abreast of industry standards and development best practices.

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  • Supports and carries out the AmeriHealth Caritas Mission and Values.

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", "identifier" : { "name" : "Amerihealth Caritas Health Plan", "value" : "14248", "@type" : "PropertyValue" }, "@context" : "http://schema.org", "@type" : "JobPosting" }

Business Systems Analyst Senior

Location: Philadelphia, PA

Telecommuter?: No

ID**: 14248

Job Brief

Analyze Business Requirements and create clear & concise Functional Specifications according to standards for technical staff to use in Detailed Design and software development.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us atwww.amerihealthcaritas.com.

Responsibilities:

Work directly with business clients, PMO, all levels of management, technical staff, architects, and vendors to analyze Business Requirements and create clear & concise Functional Specifications according to standards for technical staff to use in Detailed Design and software development. Actively participate in requirements elicitation and apply a combination of business and technical knowledge to solve business problems with cost-effective technical solutions. Manage relationships with all stakeholders to control the flow of work. Use creative problem solving skills to remove barriers and effective communication skills to keep all parties informed regarding status. Become SME (over time) in Medicaid and Medicare software applications and interactions. Mentor junior team members.

  • Analysis and documentation of current and future processes/systems and delivery of documentation for the effective implementation of stated processes.

  • Hands-on interaction with stakeholders to create clear & concise Business Requirements, Functional Specifications, Data Flows, and/or other SDLC deliverables according to ACFC standards.

  • Manage work assigned to ACFC vendors as it relates to Medicaid and Medicare deliverables.

  • Prepare feasibility and cost analysis determinations for projects.

  • Interface with business clients, PMO, all levels of management, technical staff, architects, vendors, and others with minimal supervision to achieve project goals and initiatives.

  • Effectively communicate with all stakeholders, regardless of technical understanding, and ability to convey technical concepts to non-technical stakeholders in a manner that enables good business decision making.

  • Demonstrate superior customer focus always. Build consensus among stakeholders as it relates to large-scale business problems and issues.

  • Assist in managing large scale projects, lead appropriate resources, and determine project requirements and deliverables to ensure successful implementations to meet user needs.

  • Critically assess impacts to the business processes as well as technical process flows and lead the introduction of new concepts and business processes.

  • Develop and/or enhance a working knowledge of Medicaid and Medicare Healthcare Managed Care Activities: Marketing, Member Services, Health Services, Claims, Enrollment, Provider Relations, Finance, Vendor relationships and any other functional area in order to effectively communicate with all stakeholders.

  • Demonstrate strong problem solving capabilities and approach each problem in a logical and analytical manner with high degree of perseverance; produce definitive statement of the issues, and identification of alternative solutions, the recommended course of action, and the consequence of the decision.

  • Anticipate and keep manager and project staff informed of future or planned events that could impact implementations.

  • Use sound judgment in matters where there is established or little precedent and in keeping management informed of specific problems or events that impact the departmental or overall corporate objectives.

  • Work effectively both as a member of a team and independently; establish good judgment regarding routine, significant, and sensitive matters or those issues for which direct response is inappropriate and promptly apprise Manager.

  • Professionally lead productive meetings, deliver professional oral or written presentations.

Education/Experience:

  • Four-year degree in Management Information Systems or related field, or four years of related work experience.

  • At least eight years of experience in business and functional requirements gathering.

  • Experience in managed care required. Possess solid understanding of the industry; high level understanding business applications; sound understanding of organizational and process development.

  • Technical experience strongly preferred (solid working knowledge of programming and constructs).

  • Experience with MS Office products, including Visio and MS Project.

  • Prior experience with user stories and agile scrum development preferred.

  • Experience in Medicaid and/or Medicare strongly preferred.

  • Claims experience preferred; TriZetto Facets experience a plus.

  • Medical Management experience preferred; ZeOmega experience a plus.

  • Project management experience a plus.

  • Experience working directly with or for a software vendor a plus.

  • Working knowledge of complete SDLC required.

  • Demonstrated effective written and verbal communication skills required.

  • Proven track record of creating professional, concise, complete functional specifications.

  • Ability to manage multiple concurrent tasks and projects required.

  • Superior troubleshooting & creative problem solving skills required.

  • Ability to manage multiple tasks with changing priorities required.

  • Accommodate work schedule and works extra hours to meet crucial project deadlines as required.

  • Ability to work effectively with end-users, project teams, management, and vendors with minimal supervision required.

  • Ability to work as a member of a team, as well as individual contributor, required.

  • Working knowledge of HIPAA and X12 EDI formats a plus.

  • Working knowledge of Oracle database and tools e.g. TOAD, SQL Developer a plus.

  • MS SQL working knowledge for data research/analysis a plus.

  • Keeps abreast of industry standards and development best practices.

  • Supports and carries out the AmeriHealth Caritas Mission and Values.

EOE Minorities/Females/Protected Veterans/Disabled