Summary of this role:
The Centivo Business Analyst for Operations will be responsible spearheading the organization’s automation, efficiency and service controls based on maximizing the functionality available from our Core Claims system (Javelina) and all supporting Vendors and Centivo technology. The position will report to the Director of System Configuration.
Coordinates with all business units and external vendors during client implementations and/or conversions to determine requirements. This role assures that interfaces between internal systems and vendor interfaces meet client needs as well as operational processes.
In this position you will have the following responsibilities:
- Effectively working with end-users and operational partners to identify business needs and to ensure Vendor Implementations meet business requirements and appropriately address prioritized needs
- Function as a liaison, between business and technical resources to ensure people, process, and Vendor solutions meet or exceed the needs of our Clients and Operational areas
- Work with business partners to identify and articulate business requirements in each area. Facilitates brainstorming sessions to review solution options that will solve business needs
- Monitor the status of project tasks with clear communication to business partners
- Proactively keep abreast of Vendor/Javelina enhancements as well as how they integrate with existing solutions
- Assisting the functional owners in developing workflows, controls and procedures designed to maximize the Operational and Financial control structure while delivering efficiency
- Collaborating with the Subject Matter Expert (SME) on all aspects of functionality of the Javelina system and acting as the primary liaison with Eldorado for reported issues and enhancement requests.
- Responsible for oversight of the implementation of Javelina Upgrades and all supporting technologies. This includes coordinating user acceptance testing with the Operational leads and creating a test tracking document to validate all testing results
- Coordinating with vendors and internal developers all integration of software programs and databases
- Coordinating, along with the Business Analyst for Technology and QA staff, testing of all upgrades to technology
- Assisting the Training and Documentation function(s) in documenting appropriate procedures for consistent delivery of service
- Participating in the assessment of new technologies, new vendors and any system enhancements being contemplated
- Participating in internal and external meetings for plan design, strategy, and setup
- Developing and analyzing audit reporting to identify and improve benefit coding accuracy
Education and experience:
Candidates must have at least 5-7 years of experience with TPA and Self-Funding processes and at least 3 yrs in a business analysis role.
Knowledge, Skills & Abilities:
- Understands health insurance benefit administration in a Self-Funded environment
- Knowledge of professional and institutional claims adjudication
- Coding knowledge and experience with CPT, HCPCS, ICD9, CDT, Revenue, DRG and other relevant medical and industry-standard codes
- Exemplary customer service skills demonstrated by researching and resolving issues that are configuration related in a timely and accurate manner
- Demonstrated organizational skills and ability to work independently, problem-solve, and make decisions
- Demonstrated ability to work in a fast-paced environment managing multiple issues with pressure of production schedules and deadlines
- Demonstrated ability to work collaboratively and influence others to drive results across multiple functional teams
- Proficiency in Microsoft Office applications and other web-based software applications
- Ability to learn new proprietary computer systems