Data Management Business Systems Analyst Senior

AmeriHealth Caritas

Newtown Square, PA(remote)

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JOB DETAILS

SKILLS

Administrative Skills, Agile Programming Methodologies, Analysis Skills, Behavioral Health, Biotech and Pharmaceutical, Broadband, Business Intelligence, Business Processes, Business Solutions, Change Management, Change Order Management, Cisco Unity, Cloud Computing, Communication Skills, Compensation and Benefits, Computer Science, Content Management Systems (CMS), Cross-Functional, Data Analysis, Data Management, Data Mapping, Data Quality, Data Science, Data Sets, Decision Support, Diversity, Documentation, Electronic Data Interchange (EDI), Failure Mode and Effects Analysis (FMEA), Gap Analysis, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, Healthcare Administration, Healthcare Effectiveness Data and Information Set (HEDIS), IBM WebSphere DataStage, Informatica, Interoperability, Leadership, Managed Care, Medicaid, Medicare, Microsoft Windows Azure, Multitasking, Oracle, Oracle Database, People Management, Pharmacy, Power BI, Problem Solving Skills, Process Engineering, Product Management, Production Support, Python Programming/Scripting Language, Quality Metrics, Quality Monitoring, Query Analysis, Reconciliation, Reporting Dashboards, Requirements Management, Research Skills, Risk, Root Cause Analysis, SQL (Structured Query Language), Service Level Agreement (SLA), Snowflake Schema, Software Development, Software Development Lifecycle (SDLC), Systems Analysis, Tableau, Technical Support, Test Plan/Schedule, Traceability, Trade-Off Analysis, Usability Engineering, Vendor/Supplier Management

LOCATION

Newtown Square, PA

POSTED

2 days ago

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Role Overview

The Business Systems Analyst Senior – Data will provide techno-functional subject matter expertise for healthcare payor data initiatives, including claims, membership, provider, clinical, care management, interoperability, and population health data domains. This role will lead requirements definition, data analysis, functional specifications, source-to-target mapping, data quality validation, and cross-functional delivery across data Lakehouse and cloud data platforms.

Work Arrangement

+ This is a hybrid, office based position working in our Ellis Preserve office located in Newtown Square, PA

+ Office days are Tuesday, Wednesday, & Thursday; Remote days and Monday & Friday

Responsibilities

+ Provides ongoing support for an assigned set of systems, technologies, and capabilities, including data mapping, configuration, and queries. May serve as a SME for all or most components of a major system, understanding how information is used and how systems may need to adapt to changes in business processes

+ Leads the requirements management process for change requests, enhancements, and projects, including documenting requirements and changes such as user stories, as appropriate

+ Leads data-focused requirements management across the SDLC and Agile lifecycle, including intake, estimation, design, development support, testing, deployment, and change management

+ Provides production support for internally developed and vendor-developed applications, including researching issues, conducting root cause analysis, and performing gap analysis, typically for issues escalated from more junior team members

+ Acts as a liaison between the business and IS technical solutions/support groups, leading the definition of functional requirements, explaining changes to business processes, and communicating status. Serves as an expert advisor to the IS team to ensure delivery meets business needs

+ Researches various information and data sources and presents complex information, data, and recommendations to leadership

+ Creates and maintains functional specifications, source-to-target mappings, traceability documentation, business process maps, and other standard project deliverables such as RTM and FMEA, as applicable

+ Performs advanced SQL-based data analysis, profiling, validation, and root cause analysis across healthcare payor datasets, including claims, membership, provider, clinical, EDI, and care management data

+ Partners with data engineering, architecture, governance, business, and reporting teams to support end-to-end data delivery using platforms and tools such as Azure Data Factory, Databricks, Snowflake, Oracle, SQL, and BI/reporting tools

+ Establishes and monitors data quality SLAs, metrics, dashboards, and issue-resolution processes for business-critical datasets in partnership with data governance and business stakeholders

+ Validates reporting-layer and analytics outputs by collaborating with Power BI, Tableau, data science, and analytics teams to ensure data accuracy, completeness, consistency, and business usability

+ Provides guidance and technical knowledge to more junior team members

Education and Experience

+ At least eight (8)+ years of experience in business systems analysis, data analysis, project delivery, process re-engineering, or related business/technology roles; healthcare payor experience strongly preferred

+ At least five (5)+ years of experience in healthcare, preferably Medicaid, Medicare, managed care, payer operations, or healthcare data platforms

+ Strong SQL skills with the ability to create, interpret, and validate complex queries for data analysis, profiling, reconciliation, and business rule validation

+ Experience with data platforms such as Azure Databricks, Delta Lake, Delta Live Tables, Unity Catalog, Azure Data Factory, Snowflake, Oracle, Informatica, IBM DataStage, Kafka, Pyper, or Python

+ Knowledge of data governance, data quality frameworks, PII compliance, HIPAA, privacy standards, and data standardization practices

+ Experience with healthcare payor systems and datasets such as FACETS, claims, membership, provider, clinical, EDI transactions, care management, population health, HEDIS, CMS interoperability, or related payer data domains

+ Bachelor’s degree in computer science or equivalent years of relevant work experience

Other Skills

+ Experience in healthcare administration or a healthcare environment preferred

+ Possesses advanced expertise and knowledge of work processes for assigned business areas, including how systems are used, how information flows, how decisions are made, future roadmaps, and how systems may need to adapt to business changes

+ Demonstrates strong analytical, communication, facilitation, leadership, and stakeholder management skills, with the ability to work independently, manage multiple priorities, resolve competing needs, and guide junior team members

+ Possesses strong knowledge of business processes, products, and services across business units and how technology supports decision-making across the organization

+ Understands the business impact of different solutions and can assess and communicate tradeoffs between business needs, technology requirements, costs, and risk

+ Possesses an understanding of the general competitive landscape from a business and technology perspective

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.

About the Company

AmeriHealth Caritas

Leaders in health care solutions for those most in need

AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.

Our mission, our goal

Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.

COMPANY SIZE

5,000 to 9,999 employees

INDUSTRY

Healthcare Services

FOUNDED

1985

WEBSITE

http://www.amerihealthcaritas.com

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