Resp & Qualifications
Although this position is "REMOTE", candidate are preferred to live in the MD, DC, VA area in order to travel into local offices.
PURPOSE:
The Senior Business Analyst to support our Medicare Prescription Payment Plan (M3P) functions will have the responsibility to ensure that the business' needs for oversite and validation of services, changes to processes, policies and/or information systems are identified, understood, defined, documented and acted upon by eliciting, analyzing, documenting, validating, specifying and verifying the needs of business or user. Services, processes, policies and/or systems to include:
- Likely to Benefit Communications
- Pharmacy Claim Adjudication Process
- Pharmacy Payment Obligations and Claims Processing
- Contracted Pharmacy Transaction Costs
- Uniform Requirements for every Pharmacy Type
- Enrollee Outreach, Education and Communication Evidence of Coverage (EOC) / Annual Notice of Change (ANOC); Explanation of Benefits (EOB); Part D sponsor websites (CVS/Caremark Websites); Notification Prior to Point of Sale (POS); POS Notification Requirements / Continuous Coverage for Opted In Members
- Retroactive election Reimbursement coordination; Excess Payment Refunds
- Mid-Year Plan Election Changes
- Voluntary Terminations / Involuntary Terminations
- Process for handling overdue monthly bills
- Dispute Handling (Appeals and Grievances)
- Data Submission Requirements (CMS reporting)
The incumbent is accountable for the gathering and synthesizing of business requirements for moderate complexity software, systems, processes and/or services and translates them into specifications ensuring the business objectives are met. As the functional expert, the incumbent serves as a strategic conduit between the business area and the technical or software development team through which requirements flow.
- Data Submission Requirements (CMS reporting)
- Data Submission Requirements (Contract-PBP level Data Elements)
ESSENTIAL FUNCTIONS:
- Interprets business needs and issues by gathering, eliciting, creating, analyzing, documenting and validating the Business areas user and/or technical (functional/non-functional) requirements. Collaborates in the creation of project plans to define, organize and schedule requirements management and development activities. Facilitates requirements analysis and verification sessions. Participates in the tracking and management of open issues and assists in planning for resolution. Participates in development sessions and design reviews in order to ensure design meets user requirements.
- Responsible for the overall success of user acceptance testing, including documentation, verification and release. Implements practices and procedures for end user test plans. Identifies and documents gaps in requirement adherence or system deficiencies/defects and coordinates appropriate action through issue resolution. Leads in creating formal communication to be delivered to relevant stakeholders. Provides guidance and training to application end users.
- Identifies, documents and troubleshoots problems utilizing acquired experience and knowledge of the relationships in systems, software and processes. Collaborate with appropriate stakeholders to monitor, report and resolve issues. Participates in the development of solutions and workarounds that solve moderate to high complexity technical, system and/or business issues.
- Reviews, analyzes and creates detailed documentation of business systems, processes, software and user needs. Responsible for the written documentation of requirements in accordance with established standards, in a clear and well-organized manner. Develops and/or collaborates in key project and requirement deliverables for projects of moderate to high complexity.
- Monitors and reports project status to identify and mitigate risks and to ensure quality and timely deliverables. Coordinates assigned projects from concept through implementation. Prioritize and manage new work requests.
- Answers policy-related questions for business process, systems and software which require research and consultation with others internally and externally.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business, Information Technology, Computer Science or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years progressive experience in business analysis, systems analysis, testing or other analytical experience.
Preferred Qualifications:
- Medicare Prescription / Pharmacy experience.
- Demonstrated ability to deliver high quality, effective deliverables on-time and be a significant contributor to the development of cost-effective solutions.
- Proven understanding of business analysis core competencies.
Knowledge, Skills and Abilities (KSAs)
- High-level of knowledge and understanding of business products and services.
- Microsoft Office applications usage.
- Excellent communication skills both written and verbal.
Salary Range: $68,904 - $136,851 (salaries are based on education, experience & internal equity)
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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