Job Description :
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 system setup, configurations, and onboarding of new plans/providers. Translates configuration rules, fee schedules, contract terms, provider data, code sets and benefits into system 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 judgement and discretion to collaborate with customers on 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 cases, provide root cause analysis and corrective action plan, verify delivery of customer needs, and ensure quality delivery. Also responsible for identification, documentation, and resolution of risks, defects and issues. Analyzes market trends for competitive insight to correlate into business value statements. Uses functional and organizational knowledge to mentor Associate and Intermediate Business Systems Analysts. Leads project teams or actively participate as subject matter expert (SME) on moderately complex projects (which are cross functional, with potential regulatory risk exposure, customer service & financial impacts). Acts as face to the customer. Resolves very complex issues (may involve multiple systems) while understanding potential regulatory risk exposure and customer service & financial impacts. Includes hands-on configuration in production and test environments, incident tracking and resolution, release management, and project management. Acts as a SME on how moderately complex new enhancements/applications are developed using advanced level of understanding of end-to-end process and clear understanding of potential integration issues. Requires advanced level of understanding the end systems impact of changes across multiple/diverse 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 State.
Take a lead role with customers, Software Engineers, Architects, Capability Managers, and other team members to capture capability needs and drive quality business solutions on complex issues. 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 taking a lead role 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 for both project and production related activities on complex issues, including new strategic programs or initiatives impacting current and existing systems.
Ensure compliance for 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).
Take lead role 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 and Technology Solutions.
Other duties as assigned.
Experience with HealthEdge HRP
Hands on configuration experience
Experience working in a SaaS model
3 - 5 years in Lean/Six Sigma
3 - 5 years in the Health Insurance Industry
3 - 5 years in the Healthcare Industry
LICENSES AND CERTIFICATIONS
Information Technology Infrastructure Library (ITIL)
The Open Framework Group (TOGAF)
Project Management Professional (PMP)
Agile Project Management
Language (Other than English)
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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 position 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, 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, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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.
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