Premera Blue Cross

Business Analyst

• Translate ambiguous business needs into solid business and functional requirements for small to large projects with moderate complexity.
• Effectively elicit information to create concise, organized Business Requirement Documents (BRD) and Functional Requirement Documents (FRD) using standard, industry recognized tools and best practices.
• Manages requirements across the lifecycle of a project to ensure end user satisfaction, business stakeholder buy-in, and scope integrity.
• Data analysis and reporting.
• Identify opportunities and contribute recommendations based on analysis of requirements and future impacts.
• Partner with business unit and IT or other departments as needed to ensure successful implementation and ongoing business and/or systems support when appropriate.
• Create detailed Use Cases, User Stories and other documents to illustrate business needs.
• Facilitate meetings and Joint Application Development (JAD) sessions in a positive way to drive cross functional stakeholders to reach agreements and effective solutions.
• Meetings may include leadership.
• Conduct research and interviews subject matter experts to create "As-is" and "To-be" process flows.
• Apply critical thinking to evaluate cross functional dependencies, including upstream and downstream impacts.
• Contribute to enhancements of Business Analysis best practices and suggestions for improvements.
• Create business facing test scenarios, test scripts/cases, and mockups of data necessary to conduct testing.
• Create the traceability between requirements and scenarios to ensure business requirements are met.
• May monitor and report on testing activity and results.
• Consult with others in the development of appropriate training materials to support the needs of functional areas.
• May provide support to other entry and junior level Business Analysts.
• May investigate and research system problems and enhancements, working collaboratively with IT and business stakeholders to identify options and provide business and/or technical solutions.

Business Analyst III

Systems Engineer

• Design, configure, and implement solutions within the Genesys Cloud platform to support business requirements.
• Develop custom integrations, APIs, and call flows to enhance customer and agent experiences in the Genesys Cloud platform.
• Provide technical leadership in troubleshooting, root cause analysis, and resolution of complex issues in the Genesys Cloud platform.
• Support junior engineers by providing mentorship and skill development in the Genesys Cloud platform.
• Advise and act as resource for complex systems projects, evaluate requirements and ensure work aligns with overall systems strategy and direction.
• Reassess solutions in process when needed and adapt changes, communicate project status to project stakeholders and/or the IT organization, identify problems and collaborate directly with vendors on solutions.
• Develop and build automation for new systems solutions for complex, integrated systems, develop standards and requirements for system alignment and to incorporate best practices, review and provide feedback on complex systems solutions developed by team for implications on other systems.
• Identify trends and requirements for future systems operational and functional needs and determine how to incorporate into system development standards, conduct research on software and systems products to justify recommendations and to support purchase efforts.
• Prepare modules with complex integration considerations for production, design and build automated deployment (pipelines) use configuration management technology, deploy complex new modules, updates, and fixes within the production environment, troubleshoot standard and interoperability issues that arise during deployment.
• Review log files to ensure effectiveness of processes.
• May collaborate with vendors and IT personnel for problem resolution and interact with vendors, outsourcers, and contractors regarding system-related services.
• Build and revise operational processes for systems maintenance and problem-solving, managing problems that arise within systems to ensure mitigations are developed and implemented to reduce likeliness of reoccurrence.
• Provide response in adherence to Service Level Agreement (SLA) issues as they arise to ensure system remain functional, document and communicate complex issues/problems to leaders as appropriate, develop and drive automation solutions.
• Lead the design and development of processes and tools to improve long term performance and capacity of systems, review implications of multiple inter-related processes and identify ways to optimize performance, capacity and increase automation.
• Provide orientation and training to end users for all modified process, provide direction and mentoring to junior engineers, creating and broadly communicating appropriate documentation and best practices.
• Participate in knowledge transfer across teams, sharing expertise when appropriate.
• Perform other duties as assigned.

Genesys Systems Engineer IV

Administration

• Collect and analyze data to evaluate the effectiveness of medical policy implementation, identify and update appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines.
• Support medical policy development and implementation by identifying and updating appropriate procedure and diagnosis codes for company medical policies and UM (Utilization Management) guidelines that reflect medical necessity, experimental/investigational or other code categories.
• Provide subject matter expertise for the Medical Policy Implementation Workgroup to ensure cross-functional collaboration between Clinical Review, Healthcare Services, and other departments on coding edit decision-making related to medical policies and mitigate downstream impact.
• Perform analysis, research, and assessment in response to cross-functional requests to inform accuracy and consistency for claims processing, reimbursement, benefit, and product configuration issues.
• Develop and use data gathering tools to document and analyze patterns of code payments and denials, medical policy changes, and coding changes.
• Research and interpret medical claims utilization and program participation.
• Present findings to internal customers to assist them in managing healthcare costs and improved member satisfaction.
• Identify potential patterns and/or trending to confirm alignment of code payments, changes and denials, and medical policy changes.
• Contribute to the analysis and decision-making efforts of the provider appeal process including assessment of appropriate coding, medical record review, and Correct Coding Initiative (CCI) bundling edits, and recommend action steps regarding code configuration issues, annual utilization and review analysis.
• Maintain current knowledge of coding application for current ICD coding and other applicable coding systems that apply to medical documentation and claims.
• Provides subject matter expertise to a variety of internal committees as assigned.
• Completes special projects and other duties as assigned.

Clinical Policy Coding Administrator

Analyst

• Confer with business partners on the most complex business topics to determine business needs and report requirements to provide appropriate solutions through extracting and analyzing data for the purpose of increasing revenue, decreasing costs, and/or complying with regulations; organize other analysts and monitor technical efforts to accomplish specific goals.
• Design, develop, document, maintain, and review data extracts reports, and analyses created from complex ad hoc requests submitted by other employees throughout the company.
• Peer review the work of others in the department and others throughout the company; assess the peer review skills and processes of departments throughout the company and work with those departments on process improvements.
• Recommend and evaluate improvements to operational databases, data quality, and productivity; organize and implement changes; train team members.
• Test and document results consistent with department standards; review the work of others for completeness; create and maintain documentation standards.
• Develop dashboards to streamline communication of key data metrics and trends.
• Analyze and resolve complex problems, assessing alternatives as appropriate, and implement solutions; identify, analyze, and research errors found in the course of peer review; evaluate new procedures; direct work with other departments to implement solutions.
• Lead work teams to accomplish specific project goals.
• Prepare estimates of resources and costs needed to accomplish tasks by assessing the complexity and volume of work against the skills of those expected to complete the tasks.

Information Analyst III, Workforce Management

Manager

• Participate in the development of Clinical Program’s strategy and plan in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
• Attract, manage, and develop clinical programs teams and promote staff development to support professional growth and operational effectiveness.
• Provide timely feedback and coaching to employees to ensure continuous development to meet current and future needs of the business.
• Represent department, programs, and clinical priorities with internal executive management and key external stakeholders.
• Lead the planning of resources and systems to support implementation of Premera's clinical program strategy and operations.
• Oversee the development and ongoing measurement of operational metrics and reports.
• Coordinate work effort with Director of Clinical Programs and colleagues of multiple teams to achieve organizational efficiency and effectiveness.
• Collect, analyze, maintain, and report data on high-risk members, contractual requirements, performance guarantees, outcome measures, resource utilization, and operational metrics.
• Act as the liaison to third party organizations that support Premera's Clinical Program activities ensuring integration between programs.
• Lead and maintain a culture of continuous improvement that positively contributes to the achievement of Premera's goals.
• Lend clinical and business expertise to support business needs.
• Develop and manage department budget(s).
• Lead, support, or participate on special projects, committees or task forces as assigned.

Senior Manager, Clinical Programs – Case Management

Data Engineer

• Create, modify, and test code, forms, and scripts that construct data sets for Data Science and Business Intelligence.
• Develop, implement, and maintain ETL scripts, data models, and data pipelines.
• Translate business needs into requirements and specifications for data processes and tools.
• Troubleshoot issues and solve problems independently and collaboratively.
• Collaborate with data scientists, analysts, and business stakeholders to understand requirements.
• Perform other duties as assigned.

Data Engineer I, Workforce Management

AI Engineer

• Develop components of larger AI systems and frameworks for AI applications and products.
• Assist in the development of prototypes and minimum viable AI/ML products before contributing substantial resources.
• Assist in the implementation of large complex cloud-based AI systems by focusing on individual components.
• Support senior AI Engineers in implementing data pipelines that underly large complex AI systems.
• Assist in implementing low latency APIs within a larger microservices architecture for powering AI models and services.
• Assist in the monitoring of deployed models and participate in a reporting process that ensures optimal model performance.
• Actively participate in a team that exercises principled, agile-like development practices.
• Create and maintain thorough documentation that is consistent with team procedures, corporate policies, and expectations.
• Follow peer review procedures for all assigned work.
• Keep abreast of new tools and concepts through reading documentation or literature and actively practice skills development.
• This is a telecommuter position, working from home.