Job Description :
Position: Healthcare Payer SME/Proxy PO
Job Location: San Francisco, California
Job Description: The Healthcare Proxy Product Owner/Domain SME translates business needs into clearly defined and documented detailed, high quality requirements and/or supplemental specifications for new applications or analyzes change requests/enhancements in existing applications.
Analyzes data to determine business problems. Handles information including patient services and how the services are paid after conducting investigations and pursuing recoveries through contact with various parties. The Analyst works collaboratively within or outside the team to identify charge system weakness, to recommend changes and focused education. Will also ensure adherence to compliance policies and contracts. Knowledge and experience of Medicare & Medicaid.
Responsibilities/Tasks:
Reviews, analyzes, and evaluates business processes and associated IT application requirements.
Develops and executes test strategies, plans, scenarios, and tracks resolution to identified defects.
Defines and documents business and IT system processes. Models AS-IS and TO-BE processes.
Conducts and facilitates JAD sessions to develop and coordinate the requirements, specifications, design, and testing efforts for medium to large projects.
Analyzes business workflow and system needs for conversions and migrations; assists in data mapping.
Conducts gap analysis and uses analytical skills to identify root cause and assist with problem management.
Defines and develops test plan documentation to support system validation and/or User Acceptance Testing.
Prepares high level user documentation and training materials.
Experience/Skills Required
12+ years of experience working as a domain SME for a health plan
4+ years of Healthcare experience in any of the following:
Core Administration Modules, Claims, Enrollment & Billing Delivery, Program Management, Product Management, or Network Management
Strong consulting experience & exposure to IT Healthcare sales cycle
Preferred 4+ years of experience in one or more of the following:
Operational business process improvement, business process analysis, benchmark analysis or workflow analysis
Ability to work on claims with different LOBs such as Commercial, Medicare, Medicaid etc.
Knowledge and experience of Medicare & Medicaid state level reporting levels