Claims Editing Software Jobs in Virginia (NOW HIRING)

City/State
Richmond, VA
Work Shift
Multiple shifts available
Overview:
Sentara Health Plans is looking to hire a Senior Business System Analyst!
This is a fully remote position.
Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming .
Description
This position is responsible for support, enhancement and implementation software applications used within the organization. Oversee and directs intermediate scale projects or components of large-scale projects; develops project plans and timelines and coordination of project resources.
Incumbent will identify opportunities to leverage technologies in areas that improve and enhance business practices by designing and implementing application/product enhancements. Works with and is a liaison to customers and end-users, appropriate IT personnel and software vendors on a regular basis to align technological functionality to operational processes. Assess, research, analyze, and document stakeholder needs, selecting the appropriate information gathering and/or modeling technique to elicit requirements. Develop detailed test cases, execute them, and share results with business and tech managers for approval. Work jointly with developers to solution and provide cost and time estimates on fixes and enhancements. Performs longer term analysis and design of systems and hardware to maintain the production environments. Synthesize requirements and develop recommendations that best meet the objectives of the business. Works on project teams that are developing or modifying very complex information systems.
Education

• Bachelor's degree preferably in a field such as Computer Science, Business, Technical, Education, Information Systems, Finance, Business Administration, Accounting, Engineering, Information Technology (Required)

Or

• Candidates without a bachelor's degree with 6 or more years of relevant experience may be considered.

Experience:

• 4 years of relevant experience (Required)
• Proficiency in SQL, HTML, and CSS (Preferred)
• Experience with pricing configuration in NetworX Pricer (Preferred)
• Experience in claims editing (Required).
• NetworX Payment Bundling Administration (PBA), Optum Claims Edit System (CES) or Zelis. (Preferred)
• Experience with pricing configuration for Commercial plans (Required)
• Experience with QNXT preferred but will accept experience with Facets

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: 69,867- 116,438. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities
Talroo-IT, pricing configuration, NetworX Pricer, pricing, NetworX Payment Bundling Administration (PBA), Optum Claims Edit System (CES), Zelis, fee schedule, pricing analyst, QNXT, Facets, SQL, Medicare, Medicaid, commercial, provider agreement, provider contract, configuration analyst, configuration, pricing configuration, NetworX, Pricer, NetworX Pricer, contract implementation, business analyst, commercial health plan, health plan
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.