Overview
On Site
Full Time
Skills
Pricing
Regulatory Compliance
Payment Systems
Business Objects
Business Analysis
Medicaid
HIPAA
SQL
Scripting
Medicare
Project Management
Data Migration
Data Integration
Agile
Sprint
Optimization
Analytical Skill
Research
Incident Management
Management
Testing
PPS
Health Care
Claims Management
Critical Thinking
SAP BASIS
Law
IT Service Management
Innovation
Collaboration
Recruiting
Insurance
Finance
Professional Development
Training
Leadership
CompTIA
Customer Service
Career Counseling
Apex
Oracle Application Express
Job Details
Job#: 2080286
Job Description:
Apex Systems is hiring a Business Analyst for a major Healthcare client!
FULLY REMOTE anywhere in the US.
12 months contract to hire
4-6 years experience in the following (preferably in the healthcare space):
Benefits and Payment Configuration // Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. Knowledge of managed care information or claims payment systems preferred. Previous structured testing experience.
Compliance Coding/Prepay Compliance (Payment Integrity) // Experience in healthcare industry, preferably with managed care techniques and administrative philosophy. Experience in claims coding analysis or medical claim review/research preferred. Knowledge of Amisys claims payment system and Business Objects preferred.
Encounters // Experience with encounters or claims business analysis experience in healthcare, preferably managed care or Medicaid. Knowledge of Amisys or other claims system, HIPAA transactions (i.e. 837, 999, 824, 277) and SQL Scripting preferred.
Medicare // Experience in healthcare industry, preferably with managed care techniques and administrative philosophy. Experience in managed health care experience, preferably with Medicare. Experience working with and leading diverse teams in matrix managed environments. Project management experience preferred.
Provider Data // Experience in healthcare industry and/or working in a data driven environment. Knowledge of data migration, software enhancement/planning, and Agile preferred. Experience managing projects with a high reliance on technology.
Member & Provider Solutions // Experience in healthcare industry and/or customer service or enrollment functions. Experience managing projects with a high reliance on technology. Knowledge of data integration, software enhancements/planning and Agile preferred.
Story Behind the Need:
Our team handles Optum configuration across all lines of business. Our team currently works in sprints to assist in the completion of the releases supplied by our Optum vendor. Current key projects are duals/ICHRA implementation, turnaround time optimization and testing. We are hiring to add another analyst to our team to help us tackle these initiatives as well as help to streamline our processes along with documenting as we go.
Typical Day in the Role:
Day to day duties for this role are responding to health plan research and analysis requests and taking part in issue management if the need arises. They are also responsible for participating and contributing to team discussions around projects and initiatives. Performance for this role will be measured by completeness and execution across these different initiatives as well as how well we have been able to streamline our department processes. This role is unique because it requires critical thinking, analytical and claims configuration knowledge.
This person should ideally have strong critical thinking skills and experience with healthcare claims processing and adjudication:
Research and analysis
Issue management
Project tracking/management
Responding to questions from health plans
Testing
Preferred (but not required) experience includes:
Reimbursement methodologies
Optum PPS configuration
Additional qualities to look for: We are looking for the right analyst who will have critical thinking skills, and someone who isn't afraid to try new things or approaches on the team. This team has a large amount of seniority, and there is a need for a new way of thinking around our department's processes. It is not necessary that the candidate have configuration experience, but it is helpful for them understand how claims for healthcare payors work and are processed.
Needs to have:
Critical thinking skills
Background in claims operations
Background in reimbursement methodologies (preferred not required)
Disqualifiers:
No claims knowledge, not past critical thinking skills
Please apply online if interested!
EEO Employer
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or .
Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.
Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.
Job Description:
Apex Systems is hiring a Business Analyst for a major Healthcare client!
FULLY REMOTE anywhere in the US.
12 months contract to hire
4-6 years experience in the following (preferably in the healthcare space):
Benefits and Payment Configuration // Experience in benefits, pricing, contracting or claims and knowledge of provider reimbursement methodologies. Knowledge of managed care information or claims payment systems preferred. Previous structured testing experience.
Compliance Coding/Prepay Compliance (Payment Integrity) // Experience in healthcare industry, preferably with managed care techniques and administrative philosophy. Experience in claims coding analysis or medical claim review/research preferred. Knowledge of Amisys claims payment system and Business Objects preferred.
Encounters // Experience with encounters or claims business analysis experience in healthcare, preferably managed care or Medicaid. Knowledge of Amisys or other claims system, HIPAA transactions (i.e. 837, 999, 824, 277) and SQL Scripting preferred.
Medicare // Experience in healthcare industry, preferably with managed care techniques and administrative philosophy. Experience in managed health care experience, preferably with Medicare. Experience working with and leading diverse teams in matrix managed environments. Project management experience preferred.
Provider Data // Experience in healthcare industry and/or working in a data driven environment. Knowledge of data migration, software enhancement/planning, and Agile preferred. Experience managing projects with a high reliance on technology.
Member & Provider Solutions // Experience in healthcare industry and/or customer service or enrollment functions. Experience managing projects with a high reliance on technology. Knowledge of data integration, software enhancements/planning and Agile preferred.
Story Behind the Need:
Our team handles Optum configuration across all lines of business. Our team currently works in sprints to assist in the completion of the releases supplied by our Optum vendor. Current key projects are duals/ICHRA implementation, turnaround time optimization and testing. We are hiring to add another analyst to our team to help us tackle these initiatives as well as help to streamline our processes along with documenting as we go.
Typical Day in the Role:
Day to day duties for this role are responding to health plan research and analysis requests and taking part in issue management if the need arises. They are also responsible for participating and contributing to team discussions around projects and initiatives. Performance for this role will be measured by completeness and execution across these different initiatives as well as how well we have been able to streamline our department processes. This role is unique because it requires critical thinking, analytical and claims configuration knowledge.
This person should ideally have strong critical thinking skills and experience with healthcare claims processing and adjudication:
Research and analysis
Issue management
Project tracking/management
Responding to questions from health plans
Testing
Preferred (but not required) experience includes:
Reimbursement methodologies
Optum PPS configuration
Additional qualities to look for: We are looking for the right analyst who will have critical thinking skills, and someone who isn't afraid to try new things or approaches on the team. This team has a large amount of seniority, and there is a need for a new way of thinking around our department's processes. It is not necessary that the candidate have configuration experience, but it is helpful for them understand how claims for healthcare payors work and are processed.
Needs to have:
Critical thinking skills
Background in claims operations
Background in reimbursement methodologies (preferred not required)
Disqualifiers:
No claims knowledge, not past critical thinking skills
Please apply online if interested!
EEO Employer
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at or .
Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.
Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.