Position Description:

Capital Blue Cross has an exciting opportunity for Technical Business Analyst position to join our award-winning organization. Since 2014, Capital Blue Cross has scored higher than all health insurance providers publicly measured in the American Customer Satisfaction Index (ACSI) and is proud to be named a Best Places to work in PA, Harrisburg Magazine’s Simply the Best, and Highest Member Satisfaction J.D. Power Award.

Provides analytical, technical and problem resolution support to our Provider Network systems. Must have prior provider configuration knowledge on agreements and rates. Conducts or participates in activities related to planning, controlling and directing, and performing system enhancements/projects, testing processes and/or system changes and configuration/support. The analyst must use knowledge of existing business practices, systems, procedures, policies, current testing tools/practices and their inter-relationships to provide and ensure innovative approaches and solutions to business problems and requirements in the supported systems. The analyst is responsible for obtaining necessary approvals on systems configuration, systems testing and application changes.

Responsibilities and Qualifications:

• 5% - Supports core functional system targeted applications and tasks. Includes understanding of end to end process. Demonstrates the ability to create and run simple queries. Includes all previous grade level expectations.
• 25% - Ability to serve as a department project lead for medium scale (40-500 hours) department/corporate projects and/or maintenance activities as assigned. Includes the ability to communicate project team status updates verbally and in writing to all team members. Ability to identify potential projects risks and contingencies. Consider root cause analysis and identify process improvement opportunities.
• 10% - Ability to elicit and/or document detailed business requirements to support configuration and system changes.
• 10% - Understand end to end processes and down stream impacts when system and process changes occur. Organizes information and data to identify and explain major trends, problems, and causes. Includes all previous grade level expectations.
• 15% - Serve as a subject matter expert for two (2) business processes and technical detailed knowledge.
• 5% - Mentor less experienced staff in an informal setting. Responds to questions from internal and external customers. Act as a “coach” to staff learning department functions. Ability to document processes and procedures.
• 15% - Ability to summarize verbally and in writing advanced analytical research that is understandable to the intended audience. Ability to facilitate meetings including preparing agendas, minutes, and other documentation as needed. Communicate any roadblocks or impacts to both management and business areas.
• 15% - Performs application testing for maintenance and medium scale (40-500 hours) projects. Ability to write test plans, setup test data, execute test scenarios and document defects. Review and coordinate testing with business areas. Communicate test status and milestones to dept and project management. Serve as a test lead on projects. Evaluate and effectively communicate testing defects and negative business impacts to ensure they are being addressed with a sense of urgency.

Skills:

• Ability to configure pricing methodologies (i.e., percentage of charge, DRG rates, fee schedules, etc.)
• Ability to lead meetings and give presentations to both management and staff. Includes the ability to develop teamwork among diverse groups.
• Ability to analyze problems and issues, determine impact, and develop business solutions for system changes. Ability to act as a liaison and recommend solutions to a variety of departments, as well as other Plans and other external business partners.
• Ability to plan, organize, lead and control projects. Includes the ability to effectively communicate in writing and verbally with technical and non-technical audiences. Also includes persuasion and negotiation skills to resolve differences with skill and understanding.
• Ability to quantify and prioritize assigned activities, the ability to adapt to changing priorities, and perform duties with minimal supervision. Includes ability to act both independently and as part of a team.

Knowledge:

• Understanding of provider sequestration, provider contracting/agreements, pricing methodologies and provider incentive payments.
• Knowledge of Cognizant Trizetto’s FACETS system a plus.
• Knowledge of Cognizant Trizetto’s Contract NetworX Modeler product and/or NetworX Pricer experience
• Knowledge of the health care industry and CBC corporate structure. Includes knowledge of standards, policies, and business practices and procedures for multiple departments/systems. Is familiar with those business services, systems and/or processes provided by external business partners.
• Knowledge of data processing terminology and concepts. Includes a high level technical understanding of technologies such as Microsoft Office Suite, Crystal Reporting, Data Modeling and Intranet Technology as well as knowledge of batch and real-time processing environments. Also includes knowledge of online change methodologies (i.e. Remedy), Quality Center and Web-Based Products. Experience working with testing tools, such as HP WinRunner/QTP, and LoadRunner, especially for regression testing and performance measurement.
• Knowledge of ANSI Standards as they relate to HIPAA legislation.
• Knowledgeable and capable of conducting cost benefit analysis techniques.

Experience:

• Prefer a Bachelor's Degree in one of the following; business administration, health planning and administration, information systems, computer science; and three years' relative experience.
• Experience working with Facets® as an integrated business system that handles claims processing, membership, billing, network, clinical, customer service, and product processes. Familiar or experienced in any of the peripheral systems to Facets.

Education and Certifications:

• Prefer a Bachelor's Degree in one of the following; business administration, health planning and administration, information systems, computer science; and three years' relative experience.

Physical Demands:

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds. Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions.

About Us: Capital Blue Cross is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. As a partner in the community’s health for over 80 years, Capital Blue Cross offers employees excellent pay, bonus opportunities, benefits, health and wellness incentives, opportunities for career advancement and community involvement, and work-life balance. In return, every member of our workforce plays an important part in something much bigger: working together and making a difference every day to improve the health and well-being of our members and the communities in which they live.