Business Analyst – Operations

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

The Business Analyst reports to the Manager of USFHP Systems Configuration and is responsible for the technical fee schedule utility function for uploading and maintaining fee schedules in the TEST and Production environments of the IDX claims payment system.

This position will also be responsible for setup, analysis and adjudication of the Medicare Prospective Payment System for inpatient and outpatient [out of state] claims including but not limited to the 3M Diagnosis Related Grouping (DRG) and Tricare Outpatient Prospective Payment (OPPS) software systems.

Other responsibilities to include:

Will assist as necessary in the testing of IDX system changes to the dictionaries (procedure code, ICD9, provider, missing referral and modifier), fee schedules, claims processing screens, claims adjudication logic, and the rule bank and identify, troubleshoot and recommend solutions to any issues associated to ensure accurate claims processing.

As requested, will prepare provider financial rate variance analysis regarding fee schedule changes impacted by CMS, DHMH or other legislation.

Will assist the Manager with development and implementation of IDX projects such as maintenance of McKesson Claim Check 10.0 core configuration, Wizard and PAM modules, ICD10 initiatives, Claims Systems conversion, HCFA/DOD reporting and data submission, EDI Expansion to electronically accept new vendors, and HIPAA associated transactions.

Will also work with the Training department to update and maintain documentation on all manuals and guidelines, which govern the daily workflow as well as assist with the training of the Systems Configuration Analyst.

Requires a Bachelor’s Degree in a related field of study. Additional work experience may substitute for some educational requirements.

Requires seven to ten years of progressively more responsible experience in a managed care environment; including 5 years medical claims processing and adjustments.

Requires a minimum of 5 years medical system experience specifically including testing, coding, benefit plans, coverage categories, and maintaining dictionaries.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.