Business Systems Consultant

Business Systems Consultant at Highmark Health in Boise, Idaho, United States Job Description Company : Highmark Inc. Job Description : JOB SUMMARY This position is responsible for system configuration implementation of the strategic business and functional infrastructure of the underlying systems that support the respective business platforms for the Medicaid Business Unit market served by Highmark. Performs configuration change management activities related to benefits, business rules, screen design and functionality, templates, workflows, provider contracts, user task analysis, personalization to different plans, and user interface design and design requirements for systems setup, configurations and onboarding of new plans/providers. Translates configuration rules, fee schedules, contract terms, provider data code sets, and benefits into systems parameters to ensure accurate managed care operations (i.e. enrollment & billing, claims processing, etc.). This job supports one or more analytical aspects of the application product life cycle, including capability enablement with cross-team dependencies within a product scope. Uses significant independent judgement and discretion to collaborate with customers on the most complex issues in order to understand capability needs, gather project specifications, create business cases and cost sheet analysis, translate high-level business needs into detailed requirements for new capabilities (and change request/enhancements on existing capabilities), analyze data to determine business problems, trends, or opportunities for process improvements, create/execute test plans, provide root cause analysis and corrective action plan, verify delivery of customer needs, and ensure quality delivery. Identifies, documents, and resolves risks, defects and issues. Analyzes market trends for competitive insight to correlate into business value statements. Uses functional and organizational knowledge to mentor Associate, Intermediate, and Senior Business Systems Analysts, as well as others outside of immediate team. Leads project teams or actively participates as a SME on the most complex projects (cross functional, with potential regulatory risk exposure, customer service & financial impacts). Acts as face to the customer; primary customer contact; may negotiate project requirements versus resources with customer. Resolves the most complex issues (may involve multiple systems) and/or develops alternative solutions with understanding of potential regulatory risk exposure and customer service & financia To view full details and how to apply, please login or create a Job Seeker account