Job ID: 290116586
Last Updated: 9/23/2022
Applications Analyst, Sr.
HR Manager (Recruitment)
Accepts J-1 Visas
Applications Analyst, Sr.
CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto "Better. Together. is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.
The Applications Analyst Sr. formulates and defines system configuration scopes and objectives through research and fact-finding based on user needs, business requirements, and system parameters. The incumbent frequently interacts with department end users, providing core system functionality, analyzing user requirements, procedures and problems to automate or improve existing system capabilities, workflow and limitations. The incumbent will lead projects as well as coordinate work efforts with other project team members. The Applications Analyst Sr. provides consultation to different business areas in handling special assignments; researching member and provider data, benefits, regulatory requirements, and claims pricing and payment rules; configuring system requirements, including systematic ETL (extract, transform, load) procedures to supplement or enhance system features. The incumbent will coordinate business end users testing and acceptance. The incumbent has analytical and business expertise in various functions and can guide business to determine scope of work or project requirements. The incumbent often works independently, performs more complex analytical, and/or administrative responsibilities.
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Manages multiple, concurrent projects for completion in a thorough and timely manner.
Documents system functionalities and limitations to address business and operational requirements.
Documents reporting requirements and limitations to address business and operational requirements.
Documents system workflows to address business and operational requirements.
Facilitates or leads internal project teams to determine impact of configuration across Facets modules.
Conducts research, documents findings, works with internal and external subject matter experts (SME) to formulate conclusions or potential solutions and prepare concise reports, presentations and other documentations as needed to present to the management team.
Create test scenarios and testing schedules, including time estimates and deadlines, monitor milestone completion, track all phases of testing and provide timely reporting of issues that impact the testing progress. This includes documenting, prioritizing and tracking changes on the testing documents.
Provides analytical support and technical expertise on requests for information from Executives, Directors and other staff regarding core content data (membership, provider, claims).
Act as an Information Technology Services (ITS) liaison to the business areas, working closely with end users to answer questions regarding system functionality, triage requests for configuration or functional changes to the application, and help the business areas identify appropriate processes and procedures for effectively using the Core Systems Application.
Updates and changes system tables and other configurable elements of the application.
Develops Business Specifications based on Change Requests generated by the user community to enhance the functionality of the Facets system.
Prepares and translates Business Specifications into detailed Technical Specifications from which programmers will code. Analyzes the capabilities of the application and the development tools available to determine the technical approach, investigating alternative approaches in cases where the application and development tools do not support the business requirement.
Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time and form of desired results.
Analyzes and revises existing system logic difficulties and documentation as necessary.
Performs quality assurance review and testing of completed code and configuration changes to ensure that the business and technical specifications have been met, and that they do not produce any undesirable outcomes. Obtains business users' acceptance and sign-off where appropriate.
Assures Application Security by determining user access requirements, assigning and limiting user security level access.
Develops and conducts basic training needs with respect to Core Systems Applications' functional and navigational overview.
Supports system upgrades, assess functionality changes and stability, working with business SMEs to adopt new enhancements.
Investigates and diagnoses system faults and errors.
Analyzes data trends aimed at reducing or minimizing errors, increasing data integrity and promoting process automation.
Serves as a SME to junior level staff.
Completes other projects and duties as assigned.
Possesses the Ability To:
Assess user needs and translate those needs into business and technical specifications.
Have excellent analytical and database skills (Word, Excel, Access, Visio and PowerPoint, etc.).
Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Effectively use resources to meet project goals and deadlines.
Communicate clearly and concisely, both orally and in writing.
Identify issues and problems, develop solutions and prepare recommendations.
Collect data, identify pertinent information and prepare reports and analysis.
Establish and maintain effective working relationships with CalOptima Health's leadership and staff.
Strong organizational, analytical, problem solving and project management skills.
Exercises discretion and judgment and may coordinate/supervise a function and the work of others within the program or representing the program/project.
Multi-task, switching between tasks and projects quickly and staying in focus.
Strong teamwork and interpersonal skills to work well on cross-functional project teams in a leadership role.
Stay up to date with system release information.
Experience & Education:
Bachelor's degree in Computer Science, Information Technology, Business Administration or related field required.
5 years of relevant work experience in the health care industry, including specific experience in claims and benefits analytics required.
4 years of experience working with a major managed care application required.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
2 years of experience specifically with Trizetto Facets application preferred.
Industry standards such as CPT, ICD10, HCPCS and Revenue code sets.
The System Development Life Cycle.
Process and functionality with systems to support user requirements.
Understanding of managed care and government-sponsored health care delivery systems.
Understanding of Medi-Cal and Medicare benefits and billing guidelines related to managed care operations and issues that affect the organization
Quality standards, legislation and best practices.
Department(s): ITS- Applications Management
Reports to: Manager, Information Technology Services
FLSA status: Non-Exempt
Salary Grade: L - $37.02 - $57.64 ($77,000 - $119,900)
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
To apply, visit https://apptrkr.com/3478497
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