What are the responsibilities and job description for the IT Program Analyst - Claims (Hybrid/Remote Option) position at Partners Health Management?
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 12 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
- Public Service Loan Forgiveness Qualifying Employer
Office Location: Remote/Hybrid option; Available for any of Partners locations.
Closing Date: Open Until Filled
Primary Purpose of Position: to ensure the accurate processing and management of providers’ claim/encounters. This position ensures that claim/encounters are processed accurately and in compliance with relevant regulations, helping to maintain the integrity and efficiency of the claim/encounters system. Provide support, assist and be a technical liaison between Partners IT and Partners Claims / Encounters, and Care Management teams. Be an extension of Partners IT working alongside the business.
Roles and Responsibilities:
- Data Analysis: Analyze claim/encounter and encounters data to identify patterns, discrepancies, and potential fraud.
- Customer Support: Provide support to external and internal constituents answering inquiries and resolving issues related to claim/encounters.
- Report Preparation: They prepare detailed reports on claim/encounter incidents and trends for management and risk assessment.
- Cross-Departmental Collaboration: Works with other departments/programs to ensure seamless resolution of claim/encounters and improve overall service quality.
- Project Management: Lead and manage projects related to the implementation and enhancement of Claim/encounters information systems and technology, ensuring timely delivery and adherence to budget.
- Business Requirements: Create and/or document technical business requirements for use by developers, vendors, and business SMEs.
- Data Management: Collect, analyze, and present Claim/encounters-related data to support decision-making and optimize processes. .
- Maintenance: Collaborate with stakeholders for planned or unplanned system upgrades, patches or enhancements. Monitors systems resources and documents patches, updates and/or hotfixes.
- Testing: Serve as primary point of contact for annual testing and tabletop exercises for Claim/encounters related systems. Ensure systems meet requirements for SIT and E2E testing with the Department. Ensure regression testing is completed for all system updates and enhancements. Develop and execute test plans
- Training: Develop and deliver training programs for Claim/encounters staff on new systems and processes.
- Regulatory: Ensure system compliance with NCQA, SOC 2 Type 2, and other health plan required certifications. Adheres to all Federal and State rules and regulations pertaining to Claim/encounters operation and data privacy such as but not limited tom HIPAA.
- Processing: They oversee the processing of healthcare claim/encounters, ensuring that each claim/encounter is handled accurately and efficiently.
Perform other duties as assigned.
Knowledge, Skills and Abilities:
- Excellent understanding of hardware technology, operating systems, network and communications, multi-tiered architecture and applications.
- Knowledge in Claim/encounters practices and procedures-including understanding of state and Federal laws related to Claim/encounters practice, healthcare/medical terminology, medication names/general uses
- Ability to work closely with all levels of staff and present ideas and status clearly and professionally.
- Experience with Microsoft Word required, other Microsoft 365 suite of programs considered essential. Experience with Excel or other spreadsheet analytics software is required.
- Must be well organized, have demonstrated excellence in written and verbal communication skills, and proficiency in managing high stress situations with grace
- Ability to identify problems including complex multi-layered issues and determine potential solutions, both independently and as team member, using critical thinking skills
- Demonstrated excellence in customer service skills and strong analytical skills
- Self-motivated, self-starter
Education and Experience Required: Bachelor's degree or equivalent experience in Information Technology, Computer Science, Claim/encounters, Business or related field. Minimum of 3 years of experience in systems/business analysis and project management.
Education and Experience Preferred: Master’s degree in information technology, Computer Science, Claim/encounters , Business or related field and Five plus (5 ) years’ experience in systems/business analysis and project management and:
- Experience with Claim/encounters information systems (e.g., Epic, HSP, McKesson).
- Experience with data visualization tools (e.g., Power BI, Tableau)
- Certification in project management (e.g., PMP (PMI).
