DISTINGUISHING CHARACTERISTICS:

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1 Position Title: Business Systems Analyst I (Operations) Position Status: Exempt Reports To: Business Analyst Supervisor Effective Date: 05/04/2018 Revised Date: SUMMARY DESCRIPTION: Under direction, this position: 1. Performs analysis and is responsible for assisting with the design, testing, maintenance, configuration, development and support of Alliance information systems; 2. Collaborates with internal and external stakeholders to implement process improvements and provides analysis to inform improvement objectives; 3. Deriving system requirements in response to strategic operational objectives and policy changes promulgated by regulatory entities; 4. Communicates and collaborates with internal and external customers; and 5. Performs other duties as assigned. DISTINGUISHING CHARACTERISTICS: The Business Systems Analyst I is the entry level classification in the series and is distinguished from the next higher working level of Business Systems Analyst II by the latter s performance of analysis of more complex issues and greater degree of expert knowledge of the healthcare industry standards, responsibility for resolving more complex configurations, and the development of business requirements related to future planning activities. DUTIES AND RESPONSIBILITIES: 1. Performs analysis, and is responsible for assisting with the design, testing, maintenance, configuration, development and support of Alliance information systems, with duties including but not limited to: Performing system configuration and maintenance activities; Assisting with defining, analyzing and documenting requirements and collaborating with developers to implement solutions; Performing testing and utilizing quality control standards to ensure that work is audited, satisfies the business requirements defined in the analysis phase of the project, and is accurately implemented; Performing project management duties within the ATS Department in support of system related implementations; Extracting data through the use of reporting tools for the purpose of auditing claims data impact and to support decision making related to system configuration needs; Collecting and analyzing data to evaluate operational obstacles which include financial implications, compliance issues, and making recommendations to resolve issues; Page 1 of 5

2 Analyzing, researching and resolving provider disputes; Analyzing, interpreting and implementing policy and operational changes from the Department of Health Services (DHCS), Department of Managed Healthcare (DMHC), Centers for Medicare and Medicaid Services (CMS) and other governmental entities; Analyzing and maintaining the precision of Medicare and Medi-Cal Fee Schedules and ensuring the accuracy of claim reimbursement parameters in Alliance information systems; Analyzing and designing benefit packages with proper ICD-10, CPT-4, HCPCS code sets for configuration into Alliance information systems; Testing, analyzing and configuring new and existing benefits and plans; Disseminating benefit determinants to key stakeholders and administering benefits according to specifications; Designing new configurations or modifying existing configurations to resolve system and reporting errors; Analyzing, researching and resolving system errors generated from system use; Providing training and cross-training of end users and Analytic Operation resources related to areas of responsibility; Assisting business analyst configuration staff and internal stakeholders by providing systems support expertise and guidance for Analytics Operation s core and ancillary applications; Assisting with and maintaining standard definitions and formulas; and Assisting with more complex projects as determined appropriate by the Business Analyst Supervisor. 2. Collaborates with internal and external stakeholders to implement process improvements and provides analysis to inform improvement objectives, with duties including but not limited to: Leading and assisting with process improvement efforts optimizing system usability and business processes; Performing project management duties; Analyzing and evaluating data, procedures, interrelated processes and other information and discussing with internal stakeholders; Formulating conclusions and alternative solutions, developing effective recommendations, and making presentations; Working with business units to develop quality control objectives and performing routine audits to ensure objectives are effective and successfully implemented; Providing impact analysis and assessment and recommending solutions; Identifying, researching and gathering relevant information from a variety of sources; and Participating in system analysis, design and development. 3. Deriving system requirements in response to strategic operational objectives and policy changes promulgated by regulatory entities, with duties including but not limited to: Transforming stakeholder and organizational needs into actionable requirements to inform business strategy and management; Acting as primary liaison between business users and technology to translate requirements into functional specifications; Page 2 of 5

3 Monitoring and maintaining data exchange processes and procedures; Participating in the development of internal guidelines and Standard Operating Procedures; Establishing, documenting and maintaining efficient workflows for system, data and reporting tasks; Developing, optimizing and troubleshooting business applications that support operations and business objectives; and Developing test plans, testing execution, documenting and tracking of issues to ensure timely resolution. 4. Communicates and collaborates with internal and external customers, with duties including but not limited to: Maintaining productive, collaborative working relationships with internal and external entities to increase communication and business processes; Responding to inquiries and researching and resolving systemic errors or flaws in current business processes; Communicating and monitoring project progress towards objectives while minimizing exposure to risk; Performing project management tasks, such as creating and executing project work plans and making revisions to meet changing needs and requirements; Communicating project implementation, updates and changes to all affected departments and stakeholders; Providing organizational-wide support and expertise in reporting standards, State Policy and Procedure implementation and system configuration. EDUCATION AND EXPERIENCE: Bachelor s degree in Information Technology, Computer Science, Business Administration, Healthcare, Computer Engineering, or a related field and a minimum of one (1) year of business analysis experience in a Medi-Cal or Managed Care environment or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying. JOB SPECIFIC KNOWLEDGE, SKILLS AND ABILITIES: Working knowledge of formal testing methodologies and the tools and techniques related to the development and execution of test plans and documentation of testing results; Working knowledge of software product lifecycle management, from defining requirements to implementation; Working knowledge of and proficiency with Windows based PC systems and Microsoft Word, Outlook, PowerPoint, and Excel, as well as report-generating software; Working knowledge of research, analysis and reporting methods; Some knowledge of Medi-Cal and Medicare programs; Some knowledge of medical billing and health care data interfaces; Some knowledge of data visualization approaches; Some knowledge of the principles and practices of project management ; Ability to manage multiple projects simultaneously, organize work, maintain accurate records, and achieve goals and timelines; Ability work collaboratively with individuals at all levels in a matrix organization while Page 3 of 5

4 supporting multiple stakeholders; Ability to perform technical and non-technical troubleshooting and diagnose and resolve problems efficiently and effectively; Ability to collect, interpret and evaluate data and to project consequences of recommendations; Ability to work collaboratively and productively with internal and external entities in order to achieve efficient and timely solutions; Ability to collaborate with project leads, business analysts, end users and third party contractors to assist with the design, development, testing, implementation, and documentation of solutions; Ability to translate data into understandable information and deliver solutions that improve business processes; Ability to demonstrate flexibility and creativity, identify improvements to existing practices, and to effectively adapt to change; Ability to interpret and apply rules, regulations, policies, procedures and guides; Ability to write routine reports and provide analytical conclusions of data; Ability to ensure confidentiality and privacy on all external communication; and Ability to work independently with minimal supervision and as a member of a team. ALLIANCE STANDARD KNOWLEDGE, SKILLS AND ABILITIES: Ability to communicate effectively, both orally and in writing; Ability to establish and maintain effective and cooperative working relationships with Alliance staff and others contacted in the course of the work; Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position; Ability to think and work effectively under pressure and accurately complete tasks within established times; Ability to prioritize tasks and meet deadlines; Ability to maintain confidentiality; and Valid California Driver License, transportation and automobile liability insurance in limits acceptable to the Alliance. DESIRABLE QUALIFICATIONS: Certified Business Analysis Professional or Certification of Competency in Business Analysis. Thorough knowledge of MS Word and Excel. Working knowledge of the healthcare industry and regulatory standards. Working knowledge of SQL, Tableau, and eligibility software, and data extraction tools. WORK ENVIRONMENT AND PHYSICAL DEMANDS: Ability to sit in front of and operate a video display terminal for extended periods of time; Ability to bend, lift and carry objects of varying size weighing up to 10 pounds; and Ability to travel to different locations in the course of work. Page 4 of 5

5 ALL ALLIANCE EMPLOYEES ARE EXPECTED TO: Comply with all Alliance safety requirements; and Adhere to all Alliance policies and procedures. The job duties, elements, responsibilities, skills, functions, experience, educational factors, and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Alliance reserves the right to revise this job description at any time. Page 5 of 5