Clinical Business Analyst (W2 Only)

Job Title: Clinical Business Analyst

Location: New York, NY , 10004

Job type: Contract

Scope of Role & Responsibilities

• Serve as the main point of contact for the Claims Processing 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 claims 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 Claims department and collaborate with the Consultant to identify solutions for improvement.
• By working with the Consultant, identify industry best practices to enhance the claims operations and drive system improvements.
• In partnership with the Consultant and Vice President of Claims Operations, confirm that the product roadmap includes all requirements for claims processing, the configuration/development work is prioritized appropriately, and all enhancements are identified based on business value.
• Review all claims 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 Claims department 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 assigned

Required Education, Training & Professional Experience

• Bachelor s Degree in Business Administration or related field; and
• Proven experience (5+ years) in a Business Analyst role focused on medical claims processing and operations, experience in behavioral health claims processing preferred; 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.