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Business Systems Analyst

Kforce has a client in search of a Business Systems Analyst in Monterey Park, California (CA).Summary:For DHCS Capitation Rates Development Division SFY 17-18 Private and Public Hospital Payment Programs, the Senior Business System Analyst acts as a SME to be responsible to gather, analyze, and document the business and system requirements, conduct data analyses, and identify all gaps among submissions, internal exclusions, and regulators' responses; and reconcile the volume charts and all submissions from hospitals. The Senior Business System Analyst is responsible to support Senior Programmer Analyst by providing all business and system requirements, QA/UAT any relevant process and data/report results; and work with all internal and external stakeholders to ensure the success of this project accurately and timely.Duties:
Understands and abides by all departmental policies and procedures as well as the organization's Standards of Conduct and Corporate Compliance Program
Attends mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class
Participates actively in ensuring that all state and federal rules and regulations are followed as they apply to this position
Abides by all applicable laws and regulations as mandated by state and federal laws and prevents being excluded or sanctioned from any state and/or federal programs as they pertain to healthcare
Minimum Bachelor's degree in Computer Science, Information Technology (IT) or related discipline that includes technology concentrations from an accredited university
A Master's degree in Computer Science related discipline is desirable
Minimum of 7years of related experience working in a managed care environment, preferably in a data analysis, operation management, and informatics position
Minimum of 7 years of prior experience with State and Federal regulatory data standards and requirements
Ability to comprehend and work with HIPAA standard transaction sets, specifically 837P, 837I
Knowledge of healthcare management in IPA, Hospital, Provider Network Operations, Member Enrollment, Claim Process, Medical Payment and Revenue Reporting, and Encounter submissions and measures
Proficient in MS Access and Oracle database, SQL, and MS Office
Ability to conduct comprehensive data analyses, find the root causes of the rejections and issues, and interpret business requirements, data, to identify the opportunities for the gap analyses
Lead, manage, and assist all aspects of the project, including gathering business and system requirements, translate to functional requirements, support Senior Programmer analyst to reconcile all volume charts and hospital encounter submissions
Ability to take the initiatives to develop methodologies, strategic plan to optimize the process and performance
Ability to write analytical reports and comprehensive summaries
Ability to effectively communicate with management and staff, as well as with external submitters
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status. Compensation Type: Hours


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