Key Responsibilities
- Lead the analysis and development of business requirements, test criteria, and data mappings for a critical initiative migrating a claims processing system from a hosted environment to a cloud infrastructure.
- Collaborate with business partners, project managers, developers, and QA teams to translate requirements into functional and technical specifications that support affordability goals.
- Develop and maintain detailed data mappings, ensuring seamless translation of business functionality to maintain significant cost savings.
- Create comprehensive testing plans and test cases, working closely with QA and business teams to validate system functionality and performance.
- Model and optimize business workflow processes, identifying solution options and articulating pros and cons to recommend effective designs.
- Guide data design options, leveraging deep knowledge of application data to ensure robust system performance in the cloud environment.
- Support operations staff by developing workflow and systems procedures for post-implementation handoff.
- Provide ongoing production support, troubleshooting issues, and identifying opportunities to enhance system efficiency.
- Manage project tasks and timelines effectively, ensuring alignment with organizational objectives and stakeholder expectations.
- Contribute to additional payment integrity projects as needed, adapting to evolving business priorities.
Required Skills and Qualifications
Business Analysis (50%)
- 5+ years of experience as a Business Systems Analyst, with deep expertise in healthcare claims processing and payment integrity.
- Strong proficiency in gathering business requirements, developing functional specifications, and translating them into technical specifications.
- Experience with data mapping and transformation, with the ability to validate mappings performed by vendor partners.
- Proven ability to create testing plans, test cases, and support QA efforts to ensure system reliability and compliance.
Healthcare and Workflow Expertise (50%)
- Deep knowledge of healthcare business processes, particularly in claims, payment integrity, or related areas such as eligibility, benefits, or providers.
- Expertise in modeling and optimizing business workflows, with the ability to propose and evaluate solution designs.
- Strong understanding of application data and its role in supporting healthcare system functionality.
- Excellent project and time management skills, with experience in operations and production support in a healthcare environment.
Additional Considerations
- Experience with state or government healthcare initiatives is highly valued.
- Familiarity with cloud migration projects or cloud-based systems (e.g., AWS, Azure) is a plus.
- Knowledge of Agile methodologies or tools like Jira for project tracking is advantageous.
- Strong communication and collaboration skills to work effectively with cross-functional teams and vendor partners.
- Candidates must be local to Boston to facilitate collaboration and occasional on-site work.
Why Join Us?
This role offers an opportunity to drive a high-impact payment integrity initiative within a dynamic healthcare team. You’ll work on critical cloud migration projects, collaborate with diverse stakeholders, and contribute to a forward-thinking organization dedicated to achieving affordability and operational excellence through innovative solutions.
What is a Pipeline Job?
These roles represent future opportunities we’ve uncovered through our client discussions. We have stripped away the rigid “Must Haves,” “Mandatories,” and “Required” criteria to find the right fit for their needs. By applying for these future roles, we will complete our human-centered process to see if you are a fit while adding your profile to our database to be considered for additional openings. When you apply, rest assured a human will thoroughly review your resume and respond to you personally. We take pride in finding the right match for each job, valuing your unique talents and potential over just what’s on your resume.
W2 employees of Overture Partners who work 30 or more hours per week are eligible for the following benefits: medical (choice of 3 plans), 401(k) starting on day one, a variety of voluntary benefits including life and disability insurance, and sick time if required by law in the worked-in state/locality.
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