Business Systems Analyst 2 SOFG

If you value job security, work life balance, and opportunities for growth, join us at the New York State Office of Mental Health as a Human Resources Specialist to receive all of that and more!

Who We Are:

New York State has a large, multi-faceted mental health system that serves more than 700,000 individuals each year. The Office of Mental Health (OMH) operates psychiatric centers across the State. OMH also regulates, certifies and oversees more than 4,500 programs, operated by local governments and nonprofit agencies. Our mission is to promote the mental health of all New Yorkers, with a particular focus on providing hope and recovery for adults with serious mental illness and children with serious emotional disturbances.

What We Offer:

• NYS pension and retirement programs
• Comprehensive medical, dental, and vision plans
• Flexible spending accounts for health and dependent care
• Paid time off, including thirteen paid holidays per year, personal leave, vacation leave, and sick leave

What We Stand For:

The Mission of the New York State Office of Mental Health is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. OMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, OMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring OMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. OMH is an equal opportunity/affirmative action employer.

DUTIES DESCRIPTION:

The incumbent in this Business System Analyst 2 position will support the two billing teams (listed below) that are critical to maintaining and developing the core competencies to manage the annual revenue cycle of $1.1 billion.

The first team, Outpatient Billing and Reporting/Analytics team's responsibilities include:

• Manage systems used to claim myriad payors (Medicaid, Medicare, health plans, counties, private pay) for outpatient and residential services including the legacy and modernized billing systems. Requires analysis of claiming data including pre and post go-live revenue trends, and follow up on claim billing edits, denials, rejections, and overpayments.
• Ensure the billing system is keep updated for any changes to the Federal, State, and Payor guidelines for outpatient and residential billing. Work with the Vendor to make such changes to the system, as needed.
• Maintain various OMH billing data tables and build queries that integrate such data with other OMH data tables, including OMH electronic medical records systems and the NYS Medicaid Datawarehouse. Document such queries and processes, and perform regular and ad-hoc billing analyses to satisfy inquiries.
• Lead on the intensive annual independent, third-party audit of $600M in Disproportionate Share (DSH) payments received by OMH. In addition, prepare the annual Bad Debt analysis which is required to support more than $50M in annual Medicare reimbursements.
• Respond to any audit requests from internal groups and external agencies.

The second team, Inpatient Billing and Plan Contracting team's responsibilities include:

• Manage systems used to claim myriad payors (Medicaid, Medicare, health plans, counties, private pay) for inpatient services including the legacy and modernized billing systems. Requires analysis of claiming data and follow up on claim billing edits, denials, rejections, and overpayments. Work with the Vendor, Facilities, and Finance Staff to take necessary actions to resolve these errors.
• Monitor and resolve Medicare Return to Provider (RTP) rejections, which includes high volume of rejections due to provider enrollments. Work with the facilities on enrollment related claim issues, and prepare ongoing reports on such issues.
• Ensure the billing system is kept updated for any changes to the Federal, State, and Payor guidelines for inpatient/criminal order billing. Work with the Vendor to make such changes to the system, as needed.
• Assist with contracting efforts with health insurers, including Medicaid and Medicare Managed Care plans and Medicare Part D plans to ensure OMH is reimbursed appropriately for services rendered to patients. Further, oversee Medicare Part D (pharmacy) claiming management.
• Respond to any audit requests from internal groups and external agencies.

MINIMUM QUALIFICATIONS:

Qualified candidates must have either

A. a bachelors or higher degree AND three years of business analysis* experience where your primary duty was performing three of the five following activities:

Using business analysis techniques to elicit requirements as the foundation for the solution to the organization’s business needs (e.g., workshops, focus groups, interviews, observation, brainstorming, surveys/questionnaires, or JAD Sessions).
Using business analysis techniques for the purpose of identifying solutions aimed at improving the efficiency and effectiveness of the system, business process, or product/service to fulfill the business requirements (e.g., Data Flow Diagram, Business Process Model, Root Cause Analysis, Fish Bone Diagram, Context Diagram, Business Process Flows, or Fit-Gap Analysis).
Describing in a comprehensive written document what the system, process, or product service must do in order to satisfy the established business requirements; this includes creating, updating, and maintaining documentation through the system development life cycle (e.g., Business Case, Use Case, Business Requirement Document [BRD], Fit-Gap Analysis, Impact and Feasibility Analysis, or Change Management Analysis).

Validating requirements throughout the product/system development life cycle (SDLC) including all changes to the processes that would enable an organization to achieve its goals.
Verifying requirements throughout the product/system development life cycle (SDLC) to ensure they perform to the required specifications and are capable of achieving the design capabilities; this includes developing test plans/scenarios and logical designs, testing the scenarios, reviewing test results, identifying constraints and risks, and/or communicating with stakeholders.

Or B. a bachelor’s or higher degree AND possession of a Level 2 International Institute of Business Analysis/Certification of Capability in Business Analysis (IIBA/CCBA) Certification** AND one year of business analysis* experience where your primary duty was performing three of the five activities listed above.

Or C. possession of a Level 3 International Institute of Business Analysis/Certified Business Analysis Professional (IIBA/CBAP) Certification.**

Preferred Qualifications:

• Understand revenue cycle systems from design, operations, testing, and training perspective, such as Oracle Cerner's Soarian Financials billing application.
• Understand and experience of documenting requirements related to reimbursement methodologies (e.g., Diagnostic Related Groups (DRG), Ambulatory Payment Classification (APC), and Ambulatory Patient Groups (APG)).
• Understand government insurance plans (i.e., Medicaid and Medicare), and commercial insurances and managed care, including both claims submission and remittance statement processes, edits, and errors from a revenue cycle system perspective.
• Understand medical coding terminology (e.g., HCPCS, CPT and modifiers), to be able to communicate the business needs and rules to the Vendor consultants.

Additional Comments:

Specific scheduled hours and telecommuting availability for this position will be discussed during the interview process. The number of permissible telecommuting days for each employee will be determined by the current work demands/assignments, as well as program operational needs and employee performance/productivity, but may not exceed 50% telecommuting in a two-week payroll period.

Job Type: Full-time

Pay: From $81,705.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday
• No weekends

Work setting:

• Hybrid work

People with a criminal record are encouraged to apply

Work Location: Hybrid remote in Albany, NY 12208