Lead Provider Business Analyst
Company: MetroPlus Health Plan
Location: New York
Posted on: April 16, 2024
Job Description:
Lead Provider Business Analyst
Job Ref: 102406
Category: Professional
Department: OFFICE OF THE COO
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $100,000.00
Salary Range: $100,000.00 - $110,000.00
Empower. Unite. Care.MetroPlusHealth is committed to empowering New
Yorkers by uniting communities through care. We believe that Health
care is a right, not a privilege. If you have compassion and a
collaborative spirit, work with us. You can come to work being
proud of what you do every day.About NYC Health +
HospitalsMetroPlusHealth provides the highest quality healthcare
services to residents of Bronx, Brooklyn, Manhattan, Queens and
Staten Island through a comprehensive list of products, including,
but not limited to, New York State Medicaid Managed Care, Medicare,
Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold,
Essential Plan, etc. As a wholly-owned subsidiary of NYC Health +
Hospitals, the largest public health system in the United States,
MetroPlusHealth network includes over 27,000 primary care
providers, specialists and participating clinics. For more than 30
years, MetroPlus has been committed to building strong
relationships with its members and providers to enable New Yorkers
to live their healthiest life.MetroPlusHealthis committed to
empowering New Yorkers by uniting communities through care. We
believe that Health care is a right, not a privilege. If you have
compassion and a collaborative spirit, work with us. You can come
to work being proud of what you do every day.Position
OverviewMetroPlusHealth is embarking on a Core Processing System
transition and is seeking a highly experienced Lead Provider
Business Analyst specifically focused on provider and network
operations processes and contracts within government and commercial
products (Medicaid, Medicare, CHP, QHP, etc.). As part of this
transition, the Lead Provider Business Analyst will partner with
our consultant to support the requirements gathering, process
analysis, implementation, and testing activities. They will
understand current state processes and translate those into future
state requirements, while ensuring it aligns with the goals of the
department. They will have a holistic understanding of the
operational inter-connections of upstream/downstream processes
including, but not limited to, provider configuration and system
setup, credentialing, contracting, claims processing, and provider
payment models. The Lead Provider Business Analyst will collaborate
with the consultant and cross-functional stakeholders to conduct
discovery/scoping sessions that will result in detailed
documentation illustrating the current and future state end-to-end
workflows, a thorough list of all requirements with supporting
plans for implementation, and enhanced policies and procedures. In
addition to these activities, the Lead Provider Business Analyst
will partner with the Compliance department to ensure regulatory
requirements are met. They will also assist in testing and training
activities.Job Description
- Serve as the main point of contact for the Provider
workstream.
- In partnership with our Consultant, interview stakeholders,
gather data, and define/document business requirements while
ensuring a comprehensive understanding of needs and objectives.
This includes, but is not limited to, system configuration,
workflows, reporting, and capacity plans.
- Create an inventory of current state and future state workflows
for all provider network operational processes including downstream
processes (reporting, data feeds, and other applications).
- Identify any gaps in the current documentation of processes and
partner with the Consultant on the creation of those.
- Understand existing gaps and/or pain points within the provider
contract configurations, provider structure, payment models, etc.,
and collaborate with the Consultant to identify solutions for
improvement.
- By working with the Consultant, identify industry best
practices to enhance the provider network operations and drive
system improvements.
- In partnership with the Consultant and various key Provider
stakeholders, confirm that the product roadmap includes all
requirements for the provider and network operational processes,
the configuration/development work is prioritized appropriately,
and all enhancements are identified based on business value.
- Review all provider and network specific business requirements,
workflow documentation, policies, and procedures created by the
Consultant and confirm accuracy prior to sign off.
- Collaborate with our QA teams and the Consultant to define all
test cases, test scenarios, and acceptance criteria.
- Assist in the testing and validation of all applications used
by the Provider workstream members against established requirements
to ensure all test cases and scenarios pass.
- During testing, identify deviations from requirements and
partner with the Consultant to remedy all issues.
- Contribute to the development of training materials that will
be leveraged when conducting our formal training of team
members.
- Review all training materials created by the Consultant to
confirm accuracy and quality of materials.
- Monitor progress of the workstream and provide regular updates
to stakeholders, addressing and escalating any changes in scope or
roadblocks promptly.
- Ensure timeliness of all deliverables outlined in the project
schedule.
- Act as a liaison between the Consultant, business stakeholders,
development teams, and other critical resources, facilitating
effective communication and alignment.
- Other duties as assignedMinimum Qualifications
- Bachelor's Degree in Business Administration or related field;
and
- Proven experience (5+ years) in a Business Analyst role focused
on provider network configuration, payment models, operations;
or
- A satisfactory equivalent combination of education, training,
and experience.
- Experience in supporting at least one core processing system
migration.
- Proficiency in eliciting, documenting, and managing business
and functional requirements.
- Experience with working cross functionally to have a holistic
understanding of how the operations and corresponding processes
work.
- Excellent analytical skills with the ability to synthesize
complex information and provide actionable insights.
- Exceptional facilitation skills and proven experience at
driving consensus across multiple stakeholders.
- Proven track record of successful collaboration with
development teams to deliver high-quality system software.
- Knowledge of health plan industry regulations, guidelines,
requirements, and policies related to provider networks, provider
contracting, fee schedules, and other provider network
components.
- Demonstrated experience with provider network
testing/auditing/QA.
- A demonstrated track record of driving the organizational and
operational changes in the day-to-day business of a high-volume
operation using current and new technology, achieving service
excellence.
- Proficiency in Microsoft Office - specifically Word, Excel,
VISIO, and PowerPoint.Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Effective written and verbal communication skills in a wide
range of mediums.
- Highly detail-oriented, resourceful, and self-motivated.
- Proven presentation and organizational skills.
- Exceptional problem-solving skills and a proactive approach to
identifying and resolving challenge.
- Ability to effectively communicate with technical and
non-technical stakeholders, translating between business needs and
technical solutions.
- Strong organizational skills with the ability to manage
multiple projects and priorities concurrently.
- Polished interpersonal skills with emphasis on discretion and
diplomacy.#LI-HYBRID
Keywords: MetroPlus Health Plan, New York , Lead Provider Business Analyst, Professions , New York, New York
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