Reviews and analyzes Business Information Systems. Writes detailed descriptions of user requirements, program functions, and steps required to develop or modify computer programs. Researches and evaluates systems to meet business needs. Responsible for monitoring and improving electronic claims and payment processing, resolving any problems or rejections with electronic transmissions, working with the Reimbursement Department and outsource vendors to increase our electronic capabilities, and maintain up to date EMC agreements, specifications and software. Administrates user account for payer web sites.
Essential Job Functions
Creates and maintains specifications documentation based on user and functional requirements from which program development will be based.
Develops and maintains application processes and procedure documentation.
Analyzes and makes recommendations regarding system software changes.
Participates in joint application development meetings, contributing to the creation of the software development requirements, documenting meeting minutes and the specification changes.
Trains personnel on application use and software changes.
Performs data analysis; creates queries and reports for various projects needed for the development team.
Communicates between various departments regarding the status of software development requirements.
Continually improve the requirements documentation quality and usability.
Work to enable EDI transmissions with payers.
Ensure payments are received electronically where available.
Responsible for maintaining/reviewing current EDI specifications, software, and agreements.
Other duties as assigned by supervisor.
Responsible for the user account administration of payer web sites.
Evaluates data, reports, feedback, observations and other information in determining priorities.
Uses prior knowledge and industry specific, historical experiences in resolving problems.
Conducts all assignments as a professional and role model with a sense of urgency.
Uses professional communication and conflict resolution techniques as required.
References and reflects upon the Company mission, values, and strategic imperatives in completing and/or assigning all work.
Networks with similar titled colleagues externally.
Bachelor of Science degree or an equivalent combination of education and work experience.
Four years experience in software application development processes.
Knowledge of commercial and government health insurance billing standards.
High degree of professionalism and be able to work effectively with all employees and business associates.
Must be experienced in writing application user specifications.
Must be able to adhere to confidentiality standards and professional boundaries at all times
Attention to detail
Ability to remain calm and professional in stressful situations
Strong commitment to excellence
Quick-thinking and astute decision making skills
Effective problem-solving and conflict resolution
Excellent organization and communication skills
Ability to train and supervise staff
Must be able to speak, write, read and understand English
Occasional lifting, carrying, pushing and pulling of 25 pounds
Prolonged walking, sitting, standing, bending, kneeling, reaching, twisting
Must be able to sit and climb stairs
Must have visual and hearing acuity
Must have strong sense of smell and touch
Performs duties in an office environment during agency operating hours
Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Associated topics: analysis, analyst, business, business systems analyst, financial analytic, government, investment analyst, investment analytics, monitor, strategy