Lead Provider Business Analyst

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Position Overview

MetroPlusHealth is embarking on a Core Processing System transition and is seeking a highly experienced Lead Provider Business Analyst specifically focused on provider and network operations processes and contracts within government and commercial products (Medicaid, Medicare, CHP, QHP, etc.). As part of this transition, the Lead Provider Business Analyst will partner with our consultant to support the requirements gathering, process analysis, implementation, and testing activities. They will understand current state processes and translate those into future state requirements, while ensuring it aligns with the goals of the department. They will have a holistic understanding of the operational inter-connections of upstream/downstream processes including, but not limited to, provider configuration and system setup, credentialing, contracting, claims processing, and provider payment models. The Lead Provider Business Analyst will collaborate with the consultant and cross-functional stakeholders to conduct discovery/scoping sessions that will result in detailed documentation illustrating the current and future state end-to-end workflows, a thorough list of all requirements with supporting plans for implementation, and enhanced policies and procedures. In addition to these activities, the Lead Provider Business Analyst will partner with the Compliance department to ensure regulatory requirements are met. They will also assist in testing and training activities.

• Serve as the main point of contact for the Provider workstream.
• In partnership with our Consultant, interview stakeholders, gather data, and define/document business requirements while ensuring a comprehensive understanding of needs and objectives.  This includes, but is not limited to, system configuration, workflows, reporting, and capacity plans.
• Create an inventory of current state and future state workflows for all provider network operational processes including downstream processes (reporting, data feeds, and other applications).
• Identify any gaps in the current documentation of processes and partner with the Consultant on the creation of those.
• Understand existing gaps and/or pain points within the provider contract configurations, provider structure, payment models, etc., and collaborate with the Consultant to identify solutions for improvement.
• By working with the Consultant, identify industry best practices to enhance the provider network operations and drive system improvements.
• In partnership with the Consultant and various key Provider stakeholders, confirm that the product roadmap includes all requirements for the provider and network operational processes, the configuration/development work is prioritized appropriately, and all enhancements are identified based on business value.
• Review all provider and network specific business requirements, workflow documentation, policies, and procedures created by the Consultant and confirm accuracy prior to sign off.
• Collaborate with our QA teams and the Consultant to define all test cases, test scenarios, and acceptance criteria.
• Assist in the testing and validation of all applications used by the Provider workstream members against established requirements to ensure all test cases and scenarios pass.
• During testing, identify deviations from requirements and partner with the Consultant to remedy all issues.
• Contribute to the development of training materials that will be leveraged when conducting our formal training of team members.
• Review all training materials created by the Consultant to confirm accuracy and quality of materials.
• Monitor progress of the workstream and provide regular updates to stakeholders, addressing and escalating any changes in scope or roadblocks promptly.
• Ensure timeliness of all deliverables outlined in the project schedule.
• Act as a liaison between the Consultant, business stakeholders, development teams, and other critical resources, facilitating effective communication and alignment.
• Other duties as assigned

• Bachelor’s Degree in Business Administration or related field; and
• Proven experience (5+ years) in a Business Analyst role focused on provider network configuration, payment models, operations; or
• A satisfactory equivalent combination of education, training, and experience.
• Experience in supporting at least one core processing system migration.
• Proficiency in eliciting, documenting, and managing business and functional requirements.
• Experience with working cross functionally to have a holistic understanding of how the operations and corresponding processes work.  
• Excellent analytical skills with the ability to synthesize complex information and provide actionable insights.
• Exceptional facilitation skills and proven experience at driving consensus across multiple stakeholders.
• Proven track record of successful collaboration with development teams to deliver high-quality system software.
• Knowledge of health plan industry regulations, guidelines, requirements, and policies related to provider networks, provider contracting, fee schedules, and other provider network components.
• Demonstrated experience with provider network testing/auditing/QA.
• A demonstrated track record of driving the organizational and operational changes in the day-to-day business of a high-volume operation using current and new technology, achieving service excellence. 
• Proficiency in Microsoft Office – specifically Word, Excel, VISIO, and PowerPoint.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Effective written and verbal communication skills in a wide range of mediums.
• Highly detail-oriented, resourceful, and self-motivated.
• Proven presentation and organizational skills.
• Exceptional problem-solving skills and a proactive approach to identifying and resolving challenge.
• Ability to effectively communicate with technical and non-technical stakeholders, translating between business needs and technical solutions.
• Strong organizational skills with the ability to manage multiple projects and priorities concurrently.
• Polished interpersonal skills with emphasis on discretion and diplomacy.

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