Business Systems Analyst

Description:

SEIU Healthcare IL Benefit Funds is a dynamic healthcare organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with the delivery of health and pension benefits. Our 50+ employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance to one another to carry out our shared mission and common agreements for those we serve.

SEIU Healthcare IL Benefit Funds is seeking a highly skilled and self-motivated Business Systems Analyst (BSA) with an in-depth knowledge of business processes, systems techniques, and methodologies to join our dynamic team. As a key player in our Service Division, the BSA will be responsible for bridging the gap between our business needs and technological solutions. The ideal candidate will possess a deep understanding of claims operations, processes, strong analytical skills, and the ability to communicate effectively between technical and non-technical stakeholders.

The BSA will be responsible for analyzing business requirements and designing solutions to meet those requirements with then end user in mind, while collaborating with key stakeholders to understand business processes, gather requirements, and design effective systems solutions. They will also be responsible for testing, implementing, and maintaining software applications and systems to improve business processes. The BSA will gather and define requirements, configure and implement systems enhancements, write and execute test plans, troubleshoot and resolve complex system issues, and deliver training and guidance to end users.

The BSA must have working knowledge of healthcare claims processing, check runs, clearing houses, EDI file formats and SQL. Claim workflows process knowledge will include routing rules, provider matching, referral matching, provider contracts, rates (DRG, MSDRG, Medicare FS, UCR, Per Diem, PPO, Case Rates) and detailed proprietary pricing from the Fund’s Plans related to system setup and network management.

The BSA will work with stakeholders at the Executive and Divisional Leadership levels, applying SWOT analysis to identify optimal solutions to business problems, assure technical information is accurate and documented, and data is analyzed and definitive. The BSA will develop new process flows and functionality integration as well as adding any needed clarity to business requirements from a technical standpoint.

This role requires a strong analytical mindset, excellent communication skills, and a deep understanding of both business operations and technology.

Requirements:

The immediate responsibilities of the BSA will focus on the resolution of issues identified by Claims Operations such as but not limited to:

Increasing auto-adjudication rates

Routing rule implementation – eFlow

System auditing and best practices

Contract/Code loads and referral matching

Building, creating, and maintaining rate sheet calculators.

Benefit code mapping

Other key duties and responsibilities will include the following:

Gathering and Analysis:

Collaborate with internal and external business stakeholders to gather and document detailed business requirements.

Analyze and translate business needs into technical specifications for system development.

Conduct thorough analysis of business processes and systems to identify areas for improvement.

Collaborate with subject matter experts from multiple teams to ensure that recommendations and solutions are designed holistically.

System Design and Documentation:

Develop comprehensive system design documents, ensuring alignment with business goals and objectives.

Consult with management and users to assess and determine system and end-user requirements.

Examine, create and maintain detailed documentation of business system processes, procedures, workflows, and data structures.

Quality Assurance:

Work closely with IT and system vendors to define test cases and ensure the quality of system implementations.

Identify effective solutions for business software system issues.

Conduct thorough testing and validation of system changes to guarantee accuracy and reliability for end users.

Communication and Collaboration:

Act as a liaison between business stakeholders and the development team, analyzing and communicating stakeholder needs by translating business requirements into software requirements while demonstrating clear communication and understanding.

Excellent written and verbal communication skills, emphasizing conciseness and clarity.

Readily engage in knowledge-sharing, with a skills building focus when engaging with internal stakeholders of various aptitudes.

Collaborate with cross-functional teams to ensure, successful implementation of system enhancements.

Data Analysis & Problem Solving:

Perform in-depth data analyses to identify trends, patterns, and opportunities for process improvement.

Utilize data insights to prepare high quality analysis summaries used by organizational leaders to inform business decisions and enhance overall operations and system performance.

Analyze complex data sets to identify trends, patterns, and insights.

Troubleshoot and resolve issues related to system functionality and performance.

Continuous Improvement:

Proactively identify areas for process improvements and recommend innovative solutions.

Recommend solutions for improving and restructuring procedures.

Stay current with industry trends and technology advancements to drive continuous improvement in system capabilities.

Desired Qualifications, Experience, and Characteristics:

Professional Qualifications & Experience:

Bachelor’s Degree in Business Administration, Computer Science, Information Technology, or a related field is required.

4+ years of proven experience as a Business Analyst in the healthcare or managed care claims industry, with preference for the Taft-Hartley industry.

Strong analytical and problem-solving skills with a keen attention to detail.

Excellent written, verbal, and non-verbal communication and interpersonal skills to clearly articulate and share meaning of complex issues to a wide variety of audiences including peers, staff, leaders, and internal and external stakeholders and partners.

Strong interpersonal and consultative skills with a people-centric focus to bridge technology with successful end user experience.

Proficiency in creating detailed documentation, including business requirements, system design, and test cases.

Familiarity with healthcare data standards and regulations to ensure organizational compliance of all applicable laws.

Proven experience utilizing and applying project management methodologies in moving forward and achieving successful project planning and execution outcomes.

Demonstrated professional accountability and practiced use of self, with the commitment to manage up, laterally, and to direct reports in a collaborative manner.

Ability to collect, research, and synthesize complex information to provide data-informed recommendations in detailed reports for internal and external stakeholders, with a strong sense of insight and analytical expertise to complement the data.

Excellent organizational and time-management skills, with proven ability to develop and implement individual and group timelines, manage multiple assignments, prioritize tasks effectively, meet deadlines and objectives, and seek direction or guidance as needed in a changing and emergent environment.

Accomplished change management contributor with proven experience demonstrating resilience to setbacks and the analytical skills and discernment toward problem resolution.

Demonstrated track record of leading and working with organizations that center diversity, equity, inclusion and belonging while advocating for human and technical systems that support racial, gender and socio-economic justice in the workplace.

Personal Characteristics

Passionate commitment to the Mission, Vision, and Core Values of the SEIU Healthcare IL Benefit Funds.

Sense of grace and humor in the face of challenges.

Demonstrated creative innovation to advance and align organization culture, structure, systems and skills.

An exceptional team spirit and positive attitude, with a high degree of integrity and sound judgment to earn and keep employee and team confidence and morale.

Technical Experience

Experience with requirements gathering and documentation tools.

Knowledge of database concepts, networks, and programing language.

Advanced proficiency in Microsoft Office platforms (e.g., Access, Outlook, Teams, Word, Excel, OneNote, PowerPoint, Visio) is required.

Advanced user of benefits administration software, Basys/Bridgeway preferred.

Advanced user of project management tools, Smartsheet preferred.

Experienced facilitation in a hybrid work model, providing in-person support and reliable remote work output and relationship building.

Technical facilitation and meeting moderation in a variety of virtual conference platform settings and in-person.

Knowledgeable use of printers, copiers, scanners, fax machines, and other office equipment.

Privacy and Security Responsibilities:

This position requires the handling of Financial Information, Personal Identifiable Information (PII) and Protected Health Information (PHI) for our members and stakeholders. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII, PHI and Financial Information. Report any suspected HIPAA violation or breach to our HIPAA Privacy and Security Officers.

Career Development & Continuing Education Opportunities: Yes

Benefits:

SEIU Healthcare IL Benefit Funds offers competitive compensation and a comprehensive benefits package which includes health coverage (medical, dental, and vision) for employees and eligible dependents, including a no premium option for employee only; generous time off; and a defined benefit pension plan.

Diversity, Equity & Inclusion creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.